Healing Combat Trauma

Showing Our Gratitude - How to Thank a Veteran

Ever wanted to thank an active duty military or veteran you see out and about, while you're running your errands, but not known how?  Want to avoid a potentially awkward moment with a total stranger, but still convey your appreciation?  (Thank the ones you know, in person -- please.)  Here's a wonderful little film about how you can.  One simple gesture that sums it up, in a gracious, heartfelt way.  Let's hope THIS becomes a trend that sweeps the nation...

As the flm clip memorably says: "It's not about politics.  It's about service.  And sacrifice.  And gratitude."

Way freakin' cool...

Watch the short film here.  Watch the slightly longer, full-length film here.  Learn about more about the Gratitude Campaign here.  BTW -- this is the short version, from YouTube, below:

New Hampshire's Carol Shea-Porter Has Veterans Issues on Her Mind -- in Congress

The Boston Globe has a profile today of freshman Representative Carol Shea-Porter, the first woman to represent New Hampshire on Capitol Hill.  Shea-Porter, a former social worker, is a member of the House Armed Services Committee, and makes veterans issues a priority.  The Globe profile says that highlights of Shea-Porter's first term include "the adoption of a bill guaranteeing that those who leave the military because of injuries sustained in the line of duty do not have to repay part of their enlistment bonuses. Shea-Porter, who managed floor debate on the bill, has made the health needs of veterans and troops a priority, in part based on her experience as a former military spouse.  "I understand we may differ on policy," she said of members of Congress, "but we have an obligation to honor our commitments to these troops."  (Porter counts 67,000 veterans in her district alone in New Hampshire.)

Such a simple concept -- that we the people, via our government, honor the commitment to support the troops.  I'd like to see every politician and especially every elected official make this a priority.  But since the Globe mentioned Shea-Porter's work in this regard, I figured I'd mention it on the blog.  Forget the yellow ribbons -- actually support the troops by giving them the benefits they need and have earned.  And don't let anything stand in the way until that happens.

For a link to more resources for New Hampshire veterans, via Shea-Porter's Congressional website, click here.  To educate yourself more thoroughly on who votes what on veterans issues, click this link to the relevant section of Project Vote Smart.

On the Campaign Trail: Obama Says Veterans "Have Earned Their Benefits"

The Associated Press has a story tonight about an emotional exchange between Democratic presidential candidate Barack Obama (D-IL) and a retired Air Force veteran, Andrew Hampton, who met on the campaign trail earlier today in Iowa.

Hampton told the presidential candidate that he feared today's returning combat veterans were coming back with serious injuries and often not getting the care they deserve, because of the whims of a mercurial Congress that plays "hollow politics" with their benefits.  In an emotional moment, the older veteran got weepy when he told Obama, "We can't desert them" (veterans).  Great point, Obama conceded -- veterans have clearly "already earned" their benefits.  He promised the teary-eyed older veteran that if he were elected president, veterans healthcare would be a priority.  He would "take care of veterans as a way of encouraging future generations to enter the military, as well as provide mental health screening and adopt a "zero tolerance" policy for homeless veterans.  "We have to fund all the services that have been promised to our veterans," Obama said. "We can't play politics with it."

While in truth there's no good reason to believe any candidate's promises as anything more than just good intentions and p.r. before the election -- the more important test is what happens afterward -- still and all, it's nice to see more attention focused on veterans issues, including healthcare -- and once again it's good to see older veterans from the Vietnam era taking care of younger veterans -- making sure that they get the care and the benefits they deserve.

Rose Colored Glasses: The VA Habitually Overstates Its Own Effectiveness

(I feel bad about dinging the VA one more time here, but the reality is, until it's up to where it needs to be, it's nothing personal.  Really.  Just vision for the future, and how it could be.)

One of the true, unreserved joys of blogging about a topic like this is the camaraderie that develops among the other bloggers with a heart for the same topic (Ilona Meagher, Kathie Costos, and Jim Tabb, not to mention the IAVA blog, I'm talking about you :-).  The other day I posted an item about how PTSD payments vary hugely from state to state, and fairly arbitrarily as well; something I'd seen a brief mention of in an IAVA blog post.  Jim Tabb liked what I wrote, touched on the same topic himself, and then dug a little deeper, to find some backstory, which he blogged about yesterday, here.  Now I'm picking up the same baton and saying, "Thanks, Jim" -- what he wrote about the other day is worth reading as well.  What he found was an article from about six months ago saying, shock of shocks (tongue firmly planted in cheek), that the VA has a bad habit of overestimating what a great job it's doing with its patients.  In other words, even in the absence of the actual facilities to treat them, it's got a pretty rosy picture of how things are going.  Here's the original article -- from way before James Peake, M.D. was confirmed as the new head of the VA -- and it's entitled, to the point, "VA Medical System Isn't as Big a Success As Officials Have Asserted."

The article was originally published in the Columbus, Ohio Ledger-Enquirer, one of the McClatchy newspapers.  (McClatchy did some great independent research behind the article mentioned earlier, exposing the wide and illogical disparity in VA benefits for PTSD.)  Here's just a sampling of what they found:

Consider how returning soldiers with post-traumatic stress disorder - a major ailment to emerge from the war in Iraq _ are cared for. The VA's top health official, Dr. Michael Kussman, was asked in March about the agency's resources for PTSD. He said the VA had boosted PTSD treatment teams in its facilities.

"There are over 200 of them," he told a congressional subcommittee. He indicated that they were in all of the agency's roughly 155 hospitals.

When McClatchy asked for more detail, the VA said that about 40 hospitals didn't have the specialized units known as "PTSD clinical teams." Committees in the House of Representatives and the Senate and experts within the VA have encouraged the agency to put those teams into every hospital.

Even considering that other PTSD programs are available, there are about 30 hospitals with neither PTSD teams nor any other kind of specialized PTSD programs, although all hospitals have at least one person who specializes in the ailment, VA records show.

Thanks, Jim, for bringing this to our collective attention.  A great news item like this can really get lost in the shuffle, unless we know to look for it.

And in case we really need to spell it out why news like this is significant, it's because...well, you can't exactly fix or improve a system -- which most would argue badly needs improvement -- unless and until you recognize that there's a problem.  Everyone who's been in business ought to recognize the scenario here.  Life presents many opportunities to either dig in and deal with what's going wrong, or focus on the surfacey, soft sell and spin.  When it comes to care for veterans, there's no question what they deserve and what we want to see.  That's the point, in total.

The VA's PTSD Payments Vary Based on Where You Live - And They Shouldn't

Military.com has a very good article in yesterday's paper, called "PTSD Payments Vary from State to State."  Please take the time to read it.  It's one of those few articles where every word in it is worth knowing, and relevant to our topic.  The McClatchy Newspapers chain did some extensive independent research here.  According to the article, they took a look at "3 million disability compensation-claims records obtained under the Freedom of Information Act, as well as separate documents that the VA provided. The analysis is the first to examine the issue of state-to-state variations in compensation for those young veterans who have left the military since the war in Afghanistan began in 2001."

Okay -- and what did they find? They found that payments for PTSD disability vary widely from state to state, with no obvious reason why -- nothing deeper or more significant than how disability from PTSD is likely rated by your local VA.  So it turns out if you live in New Mexico, you're like to do better than say if you live in Montana.  There's a certain amount of complexity to this system that is worth learning.  A higher disability rating means a higher payment, but whatever you start getting paid at is what you get locked in being paid at, over time, so it's crucial to start with higher numbers, essentially, if you're young and are likely going to be relying on this check for life.  And the payments are not that high to start with.  The top of the scale, total disability, runs around $2500 a month -- and that's now -- not potentially 50 years from now, when you might still be relying on that payment.  Why VA benefits don't adjust for cost of living or inflation over time is beyond me -- seems like another thing veteran rights organizations need to take up with Congress -- congressional salaries certainly have that perk.  But nevertheless, where you start on the scale ends up being vitally important over time, and some states seemed skewed to give better results than others.  Again -- read the article, it's full of good information, and it'd be bad practice to quote the whole thing just to get that point across.  But here's some other good information from it:

The VA workers who decide PTSD cases determine whether a veteran's ability to function at work is limited a little, a lot or somewhere in between. They examine the frequency of panic attacks and the level of memory loss. The process is subjective, and veterans are placed on a scale that gives them scores - or "ratings" - of zero, 10, 30, 50, 70 or 100.

McClatchy's analysis found that some regional offices are far more likely to give veterans scores of 50 or 70 while others are far more likely to stick with scores of 10 or 30.

Consider the New Mexico and Montana offices, where there are big differences up and down the scale.

In Montana, more than three-quarters of veterans have ratings of zero, 10 or 30. In New Mexico, a majority of the veterans have ratings of 50 or 70.

On top of that, 6 percent of New Mexico veterans had the highest rating possible - 100, worth $2,527 a month - compared with just 1 percent of Montana veterans.

Because payments are loaded toward the highest end of the scale - the difference between the highest rating and the next-highest rating is more than $1,000 a month - the gap in ratings has a significant impact on how much the VA is paying, on average, to veterans in different states.

Factoring in all mental and physical disabilities, the average payment for recent veterans ranges from a high of $734 a month in the Little Rock, Ark., office to a low of $435 a month in Honolulu. In Roanoke, the average was $538.

And while we're on the subject -- the average payment is $435 a month to $734 a month?  Is anyone able to actually live on this money?

Editor's Note: Congratulations to the McClatchy Newspapers for doing independent research on this subject.  It's another case to me of journalism serving to move society forward.  In future years, getting the VA system of disparate compensation cleaned up will owe much to articles based on research like this, that showed there was a problem in the first place.  Thank you...

Don't Make it a Blue Christmas - Veterans, Depression, Suicide and the Holidays

There is a dominant impression that many of us have that suicide somehow spikes at the winter holidays.  Fortunately this turns out to be just a myth -- though there is an increase in suicide after the holidays -- perhaps in part because of the general letdown after a period of increased stress, combined with frequently crummy weather and potentially mounting financial pressure from holiday overspending.  Even if suicide didn't peak anywhere near this time of year, it's still worth looking at what can be done to help people feeling the pressure and stress of the holiday season.  Combat veterans (and their families) face special stresses at holiday times, including increased time with family and friends, often increased exposure to alcohol and drugs, and the special pangs of realizing loved ones -- combat buddies -- are no longer with them or able to celebrate the holidays with their own families (survivor's guilt).

Fortunately there are some decent resources out there for lending a hand.  First off, the generic but helpful ones; secondly, the more veteran-specific ones.

Good, generic advice:

• "Ten Tips for Coping with Holiday Stress" 
• "How to Remain Sober and Healthy During the Holiday Season"
• "Dealing with Grief in the Holiday Season"

An excellent one on "Coping with a Family Member's PTSD During the Holidays;" and

Veteran-specific advice:

• Article by a Vietnam-era vet, who tried to kill himself on his first Thanksgiving back after combat.  He's got a very interesting point of view in this article.  One of the things he says is that since he arrived in Vietnam first on Christmas morning, it was hard for him for years afterward to ever have a good Christmas.  He covers all the big topics from his point of view, including anger, flashbacks/hallucinations, fear, dread, hyper-vigilance, anxiety, intimacy issues, drug and alcohol abuse, avoidance/immersion, sleep disorders, guilt, memory loss/cognitive dysfunction, intrusive thoughts, and depression.  Pretty good stuff, and he definitely can relate.  He also talks about "anniversary reactions," which is another important topic in the discussion of veterans and combat trauma.
• Patience Mason's wonderful advice for veterans and their families.  This is a link to an article specifically on "PTSD and the Holidays," and it's quite comprehensive and excellent.  She also covers the anniversary reaction the veteran may be having, and talks about how to create a healthy balance between who can handle what at the holidays, without fostering resentment and anger between the veteran and his or her loved ones.  Excellent stuff, again from someone who can relate.

The Malady Gets a New Name (Humor)

Since there's very little humor to be found on this subject, I thought I would mention this morning's entry.  Looking over the blog statistics to see where this blog is being read, in and amongst the more serious readers, from the VA, the Pentagon, etc., I came across the search string that drew a schoolchild from the New York Public Schools here -- Brooklyn, to be exact.  He or she was looking for stories about "post-dramatic stress in soldiers coming back from Iraq or Afghanistan."  Post-dramatic, indeed.  That's some seriously dramatic stuff the troops have encountered in combat.  Wouldn't surprise me at all if it created trauma.  Cute, funny, but also...true.  Dramatic as in, way more than the ordinary person expects to see or experience.  I think the schoolkid had it right...

Upcoming Medical Conference on PTSD for Military Healthcare Providers

The fourth annual "Amygdala, Stress and PTSD Conference" will be held Tuesday, April 29, 2008, from 8:00 a.m. to 6:00 p.m., in the Sanford Auditorium at the Uniformed Services University, in Bethesda, Maryland.  The conference, which is co-sponsored by the Center for the Study of Traumatic Stress, and the Graduate Program in Neuroscience at the Uniformed Services University, is part of a series of conferences that "have brought together scientists and clinicians working towards solving the biologcal basis of post traumatic stress disorder. The conferences have focused on the neurobiology of the amygdala and stress and ptsd and have included speakers at the forefront of their fields," according to conference material.  To learn more about who's speaking at the conference, and their topics, click here.  To register for the conference, click here.

Editor's Note: the amygdala is a portion of the brain defined this way: "The amygdala is located in the middle of the brain, this almond shaped complex of related nuclei is a critical processor area for the senses. Connected to the hippocampus, it plays a role in emotionally laden memories. It contains a huge number of opiate receptor sites implicated in rage, fear and sexual feelings. It is part of the limbic system." (Source: "The Glossary of Brain Terminology.")

This year's conference topics and speakers will include:

• "Mechanism of Lasting Change in Anxiety Produced by Severe Stress in Animals" -- Robert Adamec - Memorial University - Canada;
• "Role of NMDA Receptors in Fear Extinction: Implications for PTSD Therapy" -- Michael Davis - Emory University, GA;
• "Neurotrophic Actions of Stress and Antidepressant Treatment" -- Ron Duman, Yale University;
• 'Amygdala, Stress and the Pathophysiology of Psychiatric Disorders -- Anthony Grace -- University of Pittsburgh, PA
• "Different Effects of Early Exposure and Cognitive Therapies on Fear and Avoidance" -- Arieh Shalev - Hadassah University - Israel
• "The Ontogeny of Fear and the Amygdala" -- Regina Sullivan - University of Oklahoma, OK

Further information may be obtained by contacting the Conference directly:

The Amygdala Conference
4301 Jones Bridge Rd
Bethesda, MD 20814
Info@AmygdalaConference.org

Progress in Congress on Veterans Issues

Paul Rieckhoff of the IAVA sent around this note this morning.  Worth repeating here:

Dear IAVA Supporter,

                         

This year, the holidays came a little early for IAVA.

The Senate and the House of Representatives have just agreed on a final version of the National Defense Authorization Act (NDAA) for Fiscal Year 2008, and its provisions make this bill one of the single biggest advances on veterans' issues in years.             

Here are some of the highlights, on issues that you have helped to make a national priority:                     

• Extension of VA Health Care Eligibility: After discharge, today's veterans had only two years to seek VA care or risk losing access for good. But many service-connected conditions can worsen over time, or take more than two years to become obvious - including Traumatic Brain Injury and Post Traumatic Stress Disorder. Thanks to the NDAA, today's veterans now have 5 years to seek care from the VA.    

      

• Pre- and Post-deployment Screenings for Traumatic Brain Injury: The care provided for those suffering from the signature wound of the Iraq war is still woefully inadequate, and this is a big step in the right direction. Pre- and post-deployment screenings will ensure that service members with TBIs will get the treatment and rehabilitation they need.               

• Servicemembers Family Medical Leave Act: The families of those caring for severely wounded troops were previously given only three months of job protection. As a result, many spouses and other family members at Walter Reed and other military hospitals have lost their jobs while caring for their injured husband, wife, son or daughter. The NDAA expands job protections to 26 weeks.

                   

Other items include the removal of a restriction on the VA from reaching out to veterans who need care, major improvements to the GI Bill for Reservists and members of the National Guard, increased assistance for Iraqi interpreters who have worked with our troops on the ground in Iraq, and a 3.5% pay raise for the members of our Armed Forces. Three of the advances made in this bill were items on our 2007 Legislative Agenda, and two were 'IAVA Legislative Priorities'.            

This is a major victory for veterans, and all of you who helped to make these issues a priority should be proud.            

There is still an enormous amount of work to do, and we're still learning about the unique obstacles facing the men and women coming home from Iraq and Afghanistan. But your commitment to our veterans means we'll be ready to face these challenges, and we're already looking forward to another productive year.            

This bill will make its way out of Congress within the next few days, and then be passed on to the President for his signature. Keep an eye on www.IAVA.org for the latest.            

Thank you for standing with us.            

Sincerely,

Paul Rieckhoff

Iraq Veteran
Executive Director
Iraq and Afghanistan Veterans of America

            

P.S. We're two-thirds of the way towards our year-end fundraising goal. Can you help to put us over the top? Click here to make a tax-deductible contribution now. If you haven't already, check out our holiday eBay auction before it ends on Sunday. It features some cool items that make great holiday gifts, and 100% of the money raised goes straight to IAVA.

USA Today Blogs from "An Emotional" Congressional Hearing on Veterans Suicides

The Congressional hearings on suicide prevention among veterans are going on right now in Washington, DC.  USA Today is blogging about what they're calling "an emotional hearing."  Oh, yeah.  Consider the topic!  And the effect that it has on veterans and their families, not to mention, caregivers.  Here's the link.  The coverage is short and to the point, and very, very current.

Report Calls It "Highest Year Ever for Army Suicides"

USA Today has a story today about how an upcoming report will show that this past year, more Army soldiers killed themseles than ever before.  As the article states, "A total of 109 suicides this year would equal a rate of 18.4 per 100,000, the highest since the Army started counting in 1980. The civilian suicide rate was 11 per 100,000 in 2004, according to the Centers for Disease Control and Prevention [the CDC].

According to Senator Patty Murray, whose office shared the statistics with USA Today, and who is quoted in the article, "The military hasn't erased the stigma surrounding mental health issues, so troubled soldiers often do not seek help."  "I want to say I'm surprised...But when we're not doing everything we can to deal with mental health, when we know the Army is under such stress, it's not a surprise. It has to be a wakeup call."

(Although honestly, we should be well past wake-up call on this one.)

The article also mentions efforts the Army has made to combat the problem, including "mandatory training for every soldier about mental health and establishing a program to study its suicides."   However, a troubling angle to the whole suicide phenomenon is this one -- "Research released by the Army in August shows that almost 70% of suicides in 2006 were spurred by failed relationships."

Meaning, the soldier was already under significant stress, and the death of a key relationship just piled one more stressor on, and became the proverbial "straw that broke the camel's back."

If there's a concept like "total load" with mental health issues, it could very well be that ordinarily, people are capable of handling "only so much" stress, and when more gets added to the pile, it's hard not to topple under the strain.  Each person may have their own "breaking point," whose relative location changes regularly, according to how much stress they're under, or how much support they can count on (in addition to a number of other things.)  We're also talking about a younger military here than in years past, including many who didn't expect to be signing up for such extended tours, or possibly even war in the first place (okay, they should have considered it, but many did not).  Reservists in particular -- I can think of several people I know who joined to get better civilian benefits, and weren't remotely thinking they'd end up serving in Iraq or Afghanistan.

It will be interesting when more data comes out, and is studied in greater depth, to also take a look at prevalance of suicide, and see what else it's linked to.  There's already some concern, backed up by studies, that PTSD affects some troops more than others, and suicide would seem logically to follow those same trends.

In the meantime, thanks to Patty Murray for being a great supporter of veterans.  As a longtime Washington state resident, I remember her first being elected to office, and being derided and dismissed during the campaign as a "mom in tennis shoes," whose background as a teacher didn't qualify her for anything political.  As her background material indicates, she's the daughter of a disabled World War II veteran, and she's turned out to be an ardent veterans supporter, and the first woman to serve on the Senate Veterans Affairs committee. 

For media coverage on the great things she's done to support veterans, read the lower half of this page from her Senate website.  As one Seattle newspaper describes her, she's a "workhorse, not a showhorse" -- and thankfully a very committed veterans supporter.  We need more.  (This link to Project Vote Smart shows her voting record.)

Editor's Note: In related and current news, read the transcript of Todd Bowers, IAVA's director of government affairs, remarks as he testified before Congress yesterday on the topic of veterans suicides.  The transcript of his remarks is linked here.

Caring for the Caregivers of Wounded Warriors

There's another very good article in this month's issue of Social Work Today about the special considerations involved in caring for wounded warriors -- and how to mitigate the toll that takes on the caregivers themselves.  The article is called, "Surviving Professional Stress in a Military Setting."  Granted we're talking about the stress on professional caregivers here -- social workers at Walter Reed, etc. were interviewed for the article -- but the same principles apply, even for nonprofessional caregivers, such as family and friends.  Caring for someone who's hurt, with visible or invisible wounds of war, takes its toll -- and it's important to make sure that caregivers are taking care of themselves as well, during this process.  There are some amazing, superstar performers in that category -- caregivers who are family and friends -- and I hope before too long, some of those people get the props they so richly deserve.

One of the people who comes to mind is Jennifer Briest, from Yankton, South Dakota, a special education teacher in her early 20s, with two young children, who stepped up with impressive, loving determination when her husband, Sgt. Corey Briest, suffered massive head injuries in Iraq.  Jenny fought tenaciously -- there is no other word for it -- with caregivers who were -- whoops! -- writing her husband off -- at the local VA, where he was getting fairly substandard care -- to securing a spot for him in private care, at Casa Colina in Southern California. With the right care, and with Jenny spearheading the push to get Corey the treatment he needed and deserved -- lo and behold, he got quite a bit better.  Corey's story has been featured on CBS News, etc., but I'm proud to say I was following it personally long before it made news, on her blog about him on CaringBridge, and Jennifer is every bit as much a hero, in terms of the example she's set.   It's too bad family members have to fight that hard for their veterans to get the care they need and deserve, but for as long as this is how things are, Jennifer Briest will also be a hero to me -- and many others, as well. (For those following the Briests' story, there are significant improvements after the CBS story came out; thanks to improved, specialized, and dare we say, private care.)

Editor's Note: Here's the link to the video on CBS News.  For more on the concept of "compassion fatigue," which like burnout is a very real risk for caregivers, read our earlier blog post, here.

IAVA Has Tough Questions for VA Nominee Peake

Paul Rieckhoff and the Iraq and Afghanistan Veterans of America ("IAVA") list ten great and pertinent/relevant questions for VA Secretary Nominee Peake on their blog today.  Here's the link to the actual article, but we're going to go ahead and republish the list in full because it's very doubtful that they'd mind, and so many of the  questions and concerns speak to concerns we have about ensuring that veterans get the help they need to deal with the aftereffects of combat and its trauma.  Here's the IAVA's questions for Secretary Nominee Peake:

1. In 2007, the scandal at Walter Reed finally drew attention to the tremendous obstacles facing wounded troops coming home from Iraq. But many of these issues were already coming to light years earlier, even in 2003 and 2004, when you were Surgeon General. You have said that you were unaware of any problems during your tenure. How will you ensure these mistakes aren’t repeated at VA?

2. Having worked most recently for QTC Management, a major contractor with the VA, what is your stance on expanding the role of private contractors as providers of VA services and benefits?

3. According to the Pentagon’s Task Force on Mental Health, “the current complement of mental health professionals is woefully inadequate” to provide the mental health care to today’s military. Do you agree with this assessment? Should you have done more to alleviate this shortage in the military, and how will you address this problem at VA?

4. Do you believe the current World War Two-style GI Bill adequately covers the cost of college tuition today? If not, what specific improvements to the GI Bill would you recommend?

5. As VA Secretary, would you commit to implementing immediately the VA-specific recommendations from the Dole-Shalala Commission?

6. Disabled veterans are waiting too long for their disability benefits. The number of backlogged claims has increased over 50% over the past three years to almost 400,000 pending disability claims. Just last week, a new report showed that the average time for claims processing has risen again, to 183 days. What will you do to reduce the backlog?

7. The VA budget is late again this year, and temporary funding bills leave veterans’ hospitals unable to plan their budgets accurately. Do you think mandatory VA funding is the answer?

8. According to the VA, “more than 25 percent of veterans enrolled in VA health care–over 1.7 million–live over 60 minutes driving time from a VA hospital.” This number is likely to rise because the mission in Iraq has relied heavily on National Guardsmen and Reservists, who are disproportionately from rural areas, underserved by VA hospitals and clinics. How would you better the care available to veterans living in rural areas?

9. Since 2001, 22,000 troops have been discharged from the military with a ‘personality disorder.’ Personality disorder discharges have increased 40% in the Army since the invasion of Iraq. Why do you think there has been such a dramatic increase in what are supposedly pre-existing conditions? Many have suggested that these troops are actually suffering with Post Traumatic Stress Disorder. Do you believe PTSD is being misdiagnosed?

10. You will have much less time than your predecessors to influence VA policy under this Administration. What are the top three specific changes you hope to implement during your tenure and what can you realistically hope to accomplish?

The IAVA's article concludes, "The new Secretary of the VA will inherit a department under enormous strain. With the presidential election less than a year away, he may have a small window to affect significant change. IAVA looks forward to learning whether Dr. Peake is the right candidate to hold this critical position."

---

Editor's Note: I have a few more suggestions, but it increases the list past ten, to a dozen, at least.  One would be, what are the accommodations if any being planned for treating women veterans, who may have some issues different that the general, predominantly male population of veterans, such as sexual assault along with PTSD (women are underrepresented in medical research as it is, so let's not continue this trend with women veterans); and separately, what's the overall model for medical care at the VA, especially when it comes to something like PTSD?  My apprehension is that the VA is modeling itself on HMOs, not everyone's favorite provider as is, with the goal of seeing people in as few, short appointments as possible, keeping costs down, and emphasizing pharmaceutical drugs as the primary form of treatment.

Military Psychologist Faces Own Combat Trauma

The military publication, the Voice of America, has an article today called, "Combat Psychologist Treats Trauma, and Deals with Her Own," about Heidi Squier Kraft, who served as a Navy psychologist at the combat hospital in Al-Asad, Iraq, and has recently published a book about her experiences called, Rule Number Two: Lessons I Learned in a Combat Hospital.  Here's what the basic information about the book is:

Book Description
When Lieutenant Commander Heidi Kraft's twin son and daughter were fifteen months old, she was deployed to Iraq.A clinical psychologist in the US Navy, Kraft's job was to uncover the wounds of war that a surgeon would never see.She put away thoughts of her children back home, acclimated to the sound of incoming rockets, and learned how to listen to the most traumatic stories a war zone has to offer.One of the toughest lessons of her deployment was perfectly articulated by the TV show M*A*S*H: "There are two rules of war. Rule number one is that young men die. Rule number two is that doctors can't change rule number one." Some Marines, Kraft realized, and even some of their doctors, would be damaged by war in ways she could not repair. And sometimes, people were repaired in ways she never expected. RULE NUMBER TWO is a powerful firsthand account of providing comfort admidst the chaos of war, and of what it takes to endure.

About the Author
Heidi Squier Kraft spent nine years as a psychologist for the US Navy before leaving active duty in March 2005. She lives in San Diego with her husband and children.

Click here for a link to the article in the Voice of America.  The article is a little surfacey, but still worth reading, about the special considerations of a trauma care provider who's also exposed to the same trauma in combat.  If you want to read more about women troop's experiences in the Iraq war, try also Band of Sisters: American Women at War in Iraq, by Kirsten Holmstedt.  And if you want to read a book about a combat doctor's time in Iraq, read the aptly-titled, On Call in Hell: A Doctor's Iraq War Story, by Cdr. Richard Jadick, or A Doctor Looks at War: My Year in Iraq, by Michael C. Hodges.  Those books aren't necessarily going to focus much on combat trauma, but at least they're tangentially on the topic.  And if you just plain miss M*A*S*H, there are a couple of cool items on YouTube: a tribute to the show, with a great choral version of the theme song, Suicide is Painless, playing in the background; and a straight-up acoustic guitar version of the song which is also wonderful, below: 

Trauma Listening Skills - Listening with Focus

I had an interesting lunch the other day with John Powers*, up-and-coming veterans support specialist, current studying to become a psychologist, and one of the take-aways from the lunch was his impression of just how much veterans want to be heard.  Over and over, this seems to be a theme.  The contrary impression is also true: veterans who suffered because they felt society pushed them aside, and what they had to say, when they came back from the Vietnam war -- part of why, ideally, we are somewhat more ready to listen as a society now.  We think about quotes like Paul Tillich's, that the first duty of love is to listen, something we talked about earlier in a blog entry called, "How Do Veterans Want Us to Listen to Them?"  (For everyone Googling for "gifts for returning vets," and there are quite a few who are, try thinking about what USMC Brigadier General Timothy C. Hanifen wrote here in "Three Gifts You Can Give Returning Veterans That Last a Lifetime."  For everyone who wants the Cliff Notes version, even his three keys are somewhat listening-oriented: understanding, support and affirmation.  Try giving those in a genuine or authentic way, without listening -- pretty much impossible.)  There's even a specific book we talked about lately, that veterans and their families could use to document their recent experiences, both positive and negative, in an informal and interesting approach.  (That book and its related national project is called Listening is an Act of Love.  Here's the link to that blog entry.)

There's more and more we could say on the subject, but here's the actual point, and the rest was merely prologue.  There are specific skills involved in listening to and working with trauma and those who are affected by it.  Thankfully, there are also resources on learning how.  Here is a great link, that covers quite a few approaches, in tidbit fashion -- in other words, leaves you wanting more.  The overall gist?  That listening must be very intentional, and with focus.  What is focus?  The dictionary would say, it's narrow or close examination or concentration.  It's the sense that everything else is slipping out of focus, and only one thing is at the center of attention.  Listening with focus: it's a good idea in general life, an even better idea, apparently, with those who've suffered from trauma.  Perhaps this holiday season we could begin to practice it.  Guaranteed there's an enormous need for us to learn how.

Editor's Note: That's not John's ear, btw.

A Homeless Shelter Created by and for Veterans

Being back in the New England for a few weeks, where it's bitter cold especially at night, with temperatures dropping down into the teens and below, is reminding me about a place in downtown Boston that's a homeless shelter for veterans, originally started by veterans.  Oddly enough, it's such a landmark that for years many Boston residents pass by it with only the slightest understanding of what goes on inside it.  The New England Shelter for Homeless Veterans, at 17 Court Street in downtown Boston, is, according to its website, "the nation's first and largest veteran-specific homeless shelter."  It has some interesting beginnings, which are worth quoting here:

In 1986, a group of Vietnam Veterans (Peace Foxx, Mark Helberg and Ken Smith) gathered weekly at a Veterans Outreach Center in the Greater Boston area to discuss and resolve their combat experiences. Two years later, the group visited the Vietnam War Memorial in Washington, DC and was shocked to find veterans who were homeless living in an adjacent park. Upon their return to Boston, they discovered that one-third of the nation's homeless male population are veterans.

Inspired by their experiences in Washington, DC and upon further edification of the homeless veterans' issue, the group founded the Vietnam Veterans Workshop in 1988, a not-for-profit, social service organization in Boston. They recruited Pulitzer Prize-winning playwright and local Boston resident, David Mamet, to write, produce and direct "Sketches of War," a one night theatre benefit. Proceeds from the play, which starred Donald Sutherland, Al Pacino and Michael J. Fox, were donated to Boston area shelters to benefit homeless veterans.

In 1989, according to the website, the workshop acquired a 10-year lease on the former Veterans Administration Outpatient Clinic at 17 Court Street in downtown Boston through the U.S. Department of Housing and Urban Development's Stewart B. McKinney Homeless Assistance Act. The 140,000 square foot, ten-story building provided the beginnings of a drop-in shelter for homeless veterans offering hot showers, meals, and drug and alcohol counseling. Mr. Howard Levine, a Boston attorney whose practice includes representation of commercial and not-for-profit real estate developers, retailers, and educational institutions greatly assisted in the acquisition of the building.   The following year, the Shelter was officially opened, offering "a wide range of services through five distinct programs and support services: Emergency Shelter, Transitional Housing, Single Room Occupancy Apartments, Training and Employment, and Health Care and Case Management. Each of these services assists veterans in solving the problems that led him/her to homelessness. Many of the staff and board are fellow veterans who understand and help their comrades back to recovery."  According to the website, assistance has been given to more than 12,000 veterans over the years.

There's an outreach program for the chronically homeless, an emergency shelter, a clinical psychologist on staff, etc., etc.  And it looks like over the last few years, improvements to the facility have been made as well.  (There's a very good FAQ section that details more about what the shelter does and doesn't offer.)

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Two thoughts.  One, it's great to see how this shelter came about, and it would be even greater to see that reproduced nationally, as a model.  Secondly, though, there seem to be some problems with the model.  Charity Navigator, "your guide to intelligent giving," gives the Shelter only one star out of a possible four, based on its efficiency as a charity, and a similar one star in four as to its capacity (not to house veterans, but organizationally.)  It also lists other charities which it claims do "similar" work (perhaps only somewhat similar, we haven't reviewed the information in any depth), all of which it gives higher ratings to.  Those charities include:

Charity Name	Overall Score	Overall Rating
New England Shelter for Homeless Veterans - MA	27.26
The Midnight Mission - CA	68.04
Adopt-A-Family - FL	60.79
The Shade Tree - NV	69.04
The Road Home - UT	61.74
Tri-City Homeless Coalition - CA	68.36

Here's a link to the New England Shelter for Homeless Veterans.  Here's a link to the Charity Navigator's evaluation of the Shelter.  And here's a link to information about who and what Charity Navigator is -- they've been praised by Reader's Digest, Time, Forbes, Money, the Kiplinger Letter and others.  For another great post about homelessness among veterans, and what we could and should do about it, click here, to Oldtimer's blog entry of today.  He calls ending homelessness among veterans "our vital mission," and adds, quite observantly, "our heroes are out there tonight, and it is so very cold."

Bottom line: Anything's better than being homeless in New England, especially in the severe wintertime, and the Shelter seems like a commendable effort, with a rich history.  That said, apparently it could take it up a notch as well, and as a model, it's perhaps only a rough draft, not a final form of what we should be looking for as a society.