Healing Combat Trauma

Combat Trauma and Veterans' Families

Social Work Today has an article in their current issue on "Trauma and the Military Family: Responses, Resources and Opportunities for Growth."  The article title promises more than the article actually delivers -- it's pretty slim on "responses, resources and opportunities for growth" -- but to the extent that it's at least coverage on this important topic, however minuscule, it's worth knowing about.  The article overly cites Down Range: to Iraq and Back (by Bridget C. Cantrell, Ph.D. and Chuck Dean), to the exclusion of the many other important books on the subject, and it's pretty basic.  But at least it makes the point that a combat veteran's struggles with PTSD affects not just the veteran, but his or her family as well.  The article's author, Michelle D. Sherman, Ph.D., is the director of the Family Mental Health Program at the Oklahoma City Veterans Affairs Medical Center, and she devotes the second half of the short article to discussing "Support and Family Education ("SAFE")," an "18 session family education program for people who care about someone with mental illness."  The entire curriculum of this program is on the Web, linked here, with one specific segment oriented to PTSD, linked here.  The PTSD information looks helpful, and there are two handouts included as part of it, one called "PTSD and Its Impact on the Family," linked here, and the other called "What We'd Like Our Family Members and Friends to Know about Living with PTSD," linked here.  (The last item, because it was written with the suggestions of Vietnam veterans as to what to do and not to do, is particularly interesting and practical.)  Kudos to the VA and to Dr. Sherman for making this material available to veterans and their families.

Fearmongering without Compassion at the New York Times

What's your definition of weak reporting? Mine is: something that regurgitates old news, doesn't add anything new to the common discussion, is relatively void of original insight, and where the actual writing and interviewing don't rise above ordinary or pedestrian.  Even better?  Take such a dispassionate view of your subjects that you can't even rise to the level of common concern as a reporter.  Oprah famously left broadcasting because she overempathized with her subjects; but most reporters know how to convey a modicum of concern for their subjects without getting maudlin.  It's part of what draws you in as a reader and makes you care.  Not so with the New York Times today.  They've managed to offend on all fronts, creating something much more on a par with what you'd expect from a fairly cheesy local paper, than the most famous newspaper in America.  And it's especially a letdown coming so soon after some other, truly great writing about PTSD and veterans in GQ.

There's been some excellent reporting lately on the plight of Iraq and Afghanistan veterans with combat trauma/PTSD. The Washington Post, NPR, the McClatchy Newspapers, the Hartford Courant, the Boston Globe, even the Cloquet, Minnesota Pine Journal have all had some.  But the New York Times, ahhh...no.  Not if this entry is any indication.

Today's feature story on, essentially, Killings on the Homefront -- that's the name of the slideshow that accompanies it, heck of a title -- also known as "Across America, Deadly Echoes of Foreign Battles," (speaking of lame...), totally qualifies.  That article, by Deborah Sontag and Lizette Alvarez, by the time it was reprinted in full overseas in the International Herald Tribune had become the even more salacious, and inaccurate "Iraq Veterans Leave a Trail of Death and Heartbreak in the U.S."  Geebus.  Where do we even begin?  There are so many ways the NYT, and particularly reporter Deborah Sontag, jumped the shark on this one.

They tell a tale two years two late.  They tell a tale that others have been telling for a while.  They go nowhere below the surface -- regurgitating what's been in print elsewhere, with no truly original insight or anything new or unusual or worthwhile to add to the discussion.  Their math is questionable, and their reporting is frankly, weak.  The audio file chooses to accompany the article is particularly weak.  The questions Deborah Sontag asks Jonathan Shay, M.D., Ph.D., a well-known and frequently acknowledged expert on PTSD and the military, are just unbelievably ordinary and betray no more than surface awareness of who he is and what he's contributed to veterans over the years.  If Jonathan Shay wasn't rolling his eyes at the mediocre effort being put forth to question him, he must be an extremely nice, forgiving guy.  High school journalists with a sincere interest in the subject could have done a better job.

What do we "learn"?  That Iraq and Afghanistan war veterans, in the throes of PTSD or alleged PTSD, have been known to harm themselves or others (well, the focus in this article is specifically on harming "others".)  Tell us something we don't know...But since this is old news, very old news, we wonder what drives the New York Times to publish it now?  Let's hope it's not the link with the news from Camp Lejeune, about the pregnant Marine allegedly murdered by her fellow Marine rapist.  In that case, neither of the parties had even been to war.  The timing on publishing the first in the series of articles is certainly strange...almost as though the "War Torn" series was done, and in the can, and just waiting for some tangentially-related news story to bring it out.  This wasn't it.  (Are they just peeved that they've published so little of importance on the subject, vis-a-vis other major newspapers, and had to just get something into print to save face?)

There is plenty of good reporting on the general subject.  All of the papers listed above have done great, and original, work.  Even the Norfolk County D.A.'s office in Massachusetts publishes a great video that's available on YouTube, that talks about some of the difficulties vets with PTSD have in fitting back in to society.  It's worth watching.  One telling comment, and it comes from Jonathan Shay, is that he doesn't necessarily believe that a vet's PTSD should give him a free pass where trouble with the law is concerned.  Interesting.  If anyone could have an opinion on that topic that would be worth listening to, given the number of years he's thought about the subject, and worked with counseling vets, his would be it.  But he says he's on the fence about it, and certainly doesn't recommend it.  Thinks it's an awfully complex topic, and personally stays away from being an expert witness in criminal trials, for that very reason.

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More interesting stuff, way further back in the archives from the New York Times, is the following.  "Crime Wave Not Due to War Veterans," from December 5, 1921.  (That's where our graphic is from, above.)  This is a seriously wacky article, but nonetheless makes the point: "Dr. Frank Christion, Superintendent of the Elmira Reformatory, has just completed a study of ex-service men coming out of the World War [WW I], and in a report made to the State Commission of Prisons, he dissipates [I think they mean, dispels] a widely-accepted notion that many of the crimes of violence which have been committed since the close of the war have been by ex-service men and due to their war experience."  He notes, "More than half of this group [criminals] were delinquents before they entered the service.  Delinquency was not caused by Army training." You definitely have to take that article, and Dr. Christion's pronouncements with a grain of salt -- read the article if you're curious, and you'll quickly see why.  It's very dated and unscientific -- there are some [unintentionally] hilarious "medical opinions" about whiners and the spineless that would just be so completely non-PC today.  But, it's an interesting commentary on the topic, nonetheless.  And the headline pretty much carries the day...

More interesting and relevant is another item from the NYT archives, on "Vietnam Veterans, U.S. Crime and Prison," from July 15, 1982.  (All of this stuff is online now -- how very cool.)  That last piece is so interesting.  It's about a documentary that was shown on tv at the time, called Vietnam Requiem.  The documentary is still in print, somewhere, but not readily available.  In its time, the George Peabody award from Public Broadcasting, as well as the Special Merit Award, from the Academy of Motion Pictures Arts and Sciences.  Here's something about it from the old New York Times piece:

The subject [of the documentary] is the Vietnam War combat veteran who has since been imprisoned for committing violent crimes. We are told that combat veterans have been arrested at a rate that is almost twice that of nonveterans of the same age. And a Veterans' Administration study concludes that the greater a veteran's exposure to combat the more likely is his chance of being arrested or convicted.

Okay -- that's plenty interesting.  And if true, we should be expecting the same general statistics from our veterans today.  Here's more development on that theme, though:

The film conducts separate interviews with five men currently serving prison terms. None had a criminal record prior to his military experience. ... They do not discuss the crimes they committed. They simply sit before an almost rigid camera ... and talk about their war experiences.

The profiles are constructed in chronological order. The men talk about what made them join the Army or the Marines: part of a family tradition, liking the uniform, simple idealism. Their talk is interspersed with film and television clips from the period. There are the nightly news reports with the regular death counts. There are the war protesters at home. There is the war itself coming into the living rooms of America.

But being in the thick of combat turned out to be a horror, according to the candid comments of these five men. The narration makes an interesting point: ''During World War II, the Sixth Marine Regiment served four years in the Pacific but only engaged the enemy for about six weeks. In Vietnam, the combat soldier typically served a 12-month tour of duty but was exposed to hostile fire almost every day of his tour.''

In each of the cases on this program, there was a traumatic incident involving the gory death of a buddy. This in turn sometimes resulted in the infuriated friend venting his rage on innocent Vietnamese bystanders. The men are still shaken by powerful emotions as they tell their stories. Albert (Peewee) Dobbs, former Army sergeant, is especially articulate about his experiences: ''You're 18 years old and you're wearing somebody's brains around your shirt because they got their head blown off right next to you, and that's not supposed to affect you. I can never understand that.'' Mr. Dobbs is serving a seven-and-a-half-year sentence in a Louisiana correction center for attempted armed robbery.

Returning home to a country that was not overly happy about losing the Vietnam War, the veterans found few welcoming celebrations, and they soon found themselves succumbing to nightmares, alcoholism and various forms of personal violence. All five interviewed for ''Vietnam Requiem'' were decorated for bravery. All five are understandably bitter about what happened to their lives.

[The documentary filmmakers] have certainly created a powerful document. But questions can be raised. The fact remains that the great majority of the veterans who saw combat in Vietnam have never been arrested. What are the differences between the two groups? And the phenomenon of ''post-traumatic stress disorder,'' or shell shock, is hardly new. It also afflicted World War II veterans, no matter how warmly they were greeted back home as heroes. It would be perhaps illuminating to know how many of those combat veterans ended up being arrested and convicted.

Indeed.  But the surface-shallow reporting done by the New York Times in the beginning of their "War Torn" series isn't what we're looking for.  What we need is a longterm, retrospective study of veterans by war who suffered combat trauma, and what their outcomes were.  And we also need to give special consideration to the concept broached by "Vietnam Requiem," above: that if the VA did its own study, that concluded that the "greater a veteran's exposure to combat the more likely is his chance of being arrested or convicted," then how exactly are our veterans going to fare, who have been asked to serve excruciatingly long deployments, or back-to-back, multiple tours?  It can't be good.  So, rather than taking the New York Times way out, and essentially, blaming the veterans, and throwing oil on the fire, let's figure out what we can expect the repercussions to be of serving long and frequent deployments, and what we as a nation can do to help combat veterans cope with what they've experienced. 

It certainly seems we're losing the lessons from our history here: and with so much journalism (and blogging) shining attention on the plight of combat vets with PTSD, we hardly need anything that contributes so little, as the New York Times piece did.  All the NYT piece did was ad to the image problem of combat veterans.  The moniker in the 70s was "babykiller," and it took a lot to live that down.  We seriously don't need irresponsible journalism in the most famous newspaper in America adding to the problem. If they can't do good work on this topic, just don't bother -- there are enough others who are, and right now they're just doing a dis-service to the topic, and to the veterans.  Highlight the need for help, like the Washington Post has done.  Call for the government to fund care for injured troops and their families.  But don't create some highly transparent image of veterans -- what did the International Herald Tribune call their republication of the NYT piece? -- leaving "a trail of death and heartbreak in the U.S."  Please...for veterans and readers...do a better job than this.

Superb Writing about a Vietnam Vet's PTSD and Subsequent Nervous Breakdown

GQ magazine has a superb, hauntingly beautiful (and eloquently written) article called "The Long Shadow of War."  The description reads, "As a young soldier in Vietnam, Cecil Ison saw something, something so horrific that he buried the memory of it for thirty years and swore he'd never allow it to surface again.  Then, on March 20, 2003 -- the day after we started bombing Iraq -- the past leapt up and grabbed him."

There's no two ways about it: this is the best writing I've read in years, especially on this topic.  The story is long -- but practically every sentence is a gem.  It covers most of the grand themes surrounding PTSD in really an epic sweep.  There's the Vietnam War itself, always a player; Cecil, the cantankerous Appalachian individualist at the center of the story; his lovely, long-suffering and adorable wife, who loves and attends to Cecil and his various states, and quilts something lovely for him and his brothers about their Vietnam experience; his two brothers who are also battling their own demons from war, but handling it differently; his mother, who sent all three sons off to Vietnam to fight; the VA and its therapists, who minister to Cecil in his nervous breakdown; the countryside, whose silence and remoteness helps nurture Cecil in his darkest times; and finally, the writer, Kathy Dobie, whose talent is just off the charts phenomenal.  (Although it's also a close race with Cecil himself, and his wonderful wry way of putting his life into perspective, when he can, reminiscent of the humor of that 60s icon, Richard Brautigan.)

An example, from Cecil, when Kathy the writer asks him if he's a Vietnam vet:

“Yes, I received a letter from the president of the United States one day,” he said with sardonic cheerfulness. “I was out playing Whiffle ball, just having a wonderful time, and I got the mail and it said, ‘Greetings. Your friends and neighbors have selected you to serve in the Armed Forces.’ At that point, I knew I had no friends and no neighbors.”

As just one small example of the writer's deep psychological attunement and her innate grace with language, she first bonds with Cecil, thinking about his breakdown, by sending him the opening lines from Dante's Divine Comedy: "In the middle of the journey of our life I came to myself within a dark wood where the straight way was lost."  He responds a few days later with, "The mind is a strange thing—how it can paint over harsh images for decades but then for some reason they can emerge as quickly as the bare wood on a whitewashed fence after a rain. (One thinks) this is something that other people experience but not me, until it strikes like a blow from a sledge hammer. You are most welcome to explore my condition. I’m still struggling with the fact that this is a real condition and many, many others struggle with the same thing…"

Dobie is the best writer I've read in I don't know how long, on a topic I absolutely love.  She's the author of a memoir about trauma called, The Only Girl in the Car: A Memoir, a fact which explains some of her sensitivity and emotional depth in the Cecil Ison story.  Apparently she sold that book to the publisher on the strength of the book's "brilliant writing and emotional power."  Fantastic.  What a wonderful treatment of a powerful topic, and a quirky, charismatic "hero."  (His wife is also a hero, and sounds just adorable.)

"Stop Googling Yourself, You'll Go Blind"

You learn the most interesting thing by reading your blog stats / log of who's visiting.  Today's most pressing question: What was QTC Management, Inc., of Diamond Bar, California, doing a search for "QTC Medical Services is fraudulent" today, about THEMSELVES?!  Trying to contain bad press coverage before they even get any?  Planning something fraudulent (just kidding...) or just wondering who already thinks they are?  God only knows.  But one thing is for certain:  People spend a whole lot more time trying to control their public relations, than focusing on improving quality of services delivered.  THAT would be time better spent.

There isn't much to find, in terms of volume, of articles out there suspecting QTC of actual fraud.  But there is one main article from the LA TImes in 2006, reprinted on several veterans' watchdog-type websites, which talks about its highly cozy relationship with the VA.  The most recent former head of the VA, Anthony Principi, ran QTC, and immediately after his tenure at the VA, returned to lead it; not to mention, the current head of the VA, James Peake, M.D., also comes directly from there.  IAVA president Paul Rieckhoff was quoted as saying, it raises questions that QTC seems like the farm team for the VA.

Apparently QTC had a bad habit of bloating the bill for its services -- making it, what, the Halliburton of veterans medical care?!  And it isn't the greatest that there's such a close relationship between QTC and the VA.  But as for fraud?  Wonder what they're looking for, and why they're pre-emptively looking for it.  Maybe it's like American Express registering the domain name, IHateAmericanExpress.com (which they did).  They know someone's going to, so why not beat them to the punch.  Hmmmn...

Here's some good backstory on the topic, from VA Watchdog.org.  Click link here to read.  And in the meantime, we'll leave you with the graphic to ponder yourselves:

Editor's Note: Humorous "Googling Yourself" comic is courtesy of the JoyofTech.com, linked here.  Used with permission.

A Military Dad Looks for Answers -- and Action -- in Aftermath of Soldier Son's Suicide

NPR had an excellent story on Tuesday about the proactive anguish of retired Master Sergeant Chris Scheuerman in the aftermath of his son Jason's suicide while deployed in Iraq.  It's a story everyone should read, because it raises any number of salient points about the topic, including who military psychologists are really working for anyway.

The main article is called, "Father Blames Military for Son's Suicide," and if you read the story, you'll see why that is.  The text of Army Private 1st Class Jason Scheuerman's suicide note is included, and it's quite sobering.  There are several linked stories that are well worth reading as well: The timeline of Jason's last days is here.  And the article that the Associated Press did about Jason, "A Soldier's Suicide: Did He Have to Die?" is also linked here.  If you want a short course in what the issues are surrounding young soldiers who suffer combat trauma and are driven to kill themselves, these three articles give a pretty good education in the basics.  There's no shortage of participants behaving badly, and the "system" not really "working" to protect a very troubled soldier from himself. 

It's actually pretty heart-breaking to read the story, and to put yourself in the place of the dad, who was highly tenacious about finding out what really happened to his son.  The truth gets revealed to him little by little, as documents he demanded from the Army under the Freedom of Information Act (FoIA) slowly trickle their way to his house.  The Army doesn't even initially release the son's suicide note; in fact, they say there wasn't one.  (It shows up randomly later on.)  It's pretty clear that if this were a civil situation, the "employer" would be sued for wrongdoing, and there would be the potential for an enormous jury verdict for the family.  But in this case, the employer is the Federal government, and as the dad says, when the Army psychologist is an arm of the "employer," it's very unlikely that they're going to go against their self-interest, and advocate for the troubled soldier.  According to NPR's story, Chris Scheuerman says, "Military psychologists work for the employer. Their career is ...[dependent on or tied to] the decisions they make to ensure that soldiers go back to the front. That is an inherent conflict of interest, and I believe that conflict of interest prevents the provider from being a true advocate for the patient."  Scheuerman concludes, "The psychologist who saw my son was not an advocate for his safety."

Read the articles -- Jason Scheuerman's situation is hardly unique.  (We've blogged recently about the rash of young soldier suicides, including here.)  There are way too many Jasons who aren't being helped when they need it, and who not only fall through the cracks, are sometimes even given a nudge or a push. In Jason's case, that's basically what happened.  Was it malicious?  Or just incredibly insensitive and poorly timed?  Who knows.  It certainly was tremendously ill-informed, and counter-productive.  Poor Jason and his family.  It seriously sucks to be mis-understood by everyone around you, at the time when you need help the most.  Let's hope his death isn't going to be in vain -- that's exactly what his family hopes.  I'm glad they had the courage to make their painful story public -- it will help show the way to other agonized families, in the wake of son's and daughter's suicides, how to backtrack and really find out what happened.  And probably the biggest "lesson" of the story: how do you throw someone a lifeline when they really need it, and not miss that chance?  Or worse, push them off the ledge? 

And what, if any, is the duty of care owed to a troubled soldier when he or she sees a psychologist on the battlefield?  Is it substantially different from that in civilian life?  Because it seriously seems as though Jason's case was handled poorly.  He didn't help matters -- "contributory negligence" -- but seriously, he was sick.  It's much more concerning the overall low level of perceptive, sensitive treatment with which his fairly dire case was handled, by pretty much everyone he came in contact with.  Anyway, soapbox over.  Great articles on a troubling topic.  Well worth reading and thinking about. 

One Marine's Slow Realization That He Has PTSD

The Washington Post has a brief article on Sunday by Tom Ricks, about one Marine's return from multiple tours of duty in Afghanistan and Iraq, to find that he has PSTD.  Tom Ricks is famous to many of us as the author of multiple books about being in today's military.  In fact, it's one of his books that inspired Nate Fick to become a Marine -- without which we wouldn't have had the benefit of Fick's excellent book, One Bullet Away: the Making of a Marine Officer.

The Marine Ricks profiles in the short piece is Staff Sgt. Travis Twiggs.  Apparently the full article about Twiggs is available in the January issue of the Marine Corps Gazette.  Ricks writes:

People sometimes talk about the sacrifices made by U.S. troops without grasping just what that means. In the January issue of the Marine Corps Gazette, a Marine infantryman, Staff Sgt. Travis Twiggs, recounts how he slowly came to recognize that he was suffering from post-traumatic stress disorder (PTSD) after serving one tour in Afghanistan and two in Iraq.

While you're visiting the Gazette site, you might want to check out the "Letter on PTSD from MEF Commanding Generals," which we've linked, here.  It wouldn't win any awards for clear, compelling writing -- unlike Ricks' or Fick's -- but it has an interesting graphic at the end, chock full of too much information, which nevertheless calls for PTSD to be treated early, and to be treated like any other injury, without stigma.  That is, if I'm reading the graphic right.  In which case, that's great.

Editor's Note: Tom Ricks is the Washington Post's military correspondent.  He's also the author of Making the Corps (the book that persuaded Nate Fick to become a Marine), and the controversially-titled Fiasco: the American Military Adventure in Iraq.

Wounded Caregivers Experience Secondary Traumatic Stress Injury

NPR has a wonderful story today on the effects of combat trauma on caregivers.  They profile a chaplain who had a hard time with what he saw and experienced in combat, who's back in the U.S. recovering, as an outpatient at Walter Reed.  The article profiles the chaplain's whole blended, military family, and describes how they all are coping, to varying degrees, with the trauma of war.  The article also quotes our fave Jonathan Shay, M.D., Ph.D.  And it makes the point that calling PTSD a "mental illness" is just another stigma that burdens the overall experience.  Combat stress, in a caregiver, is a secondary traumatic stress injury.  Worth thinking about...

On the same topic, the Boston Globe also has an article today about another aspect of the same topic.  The Globe article is called "Back Home, A Struggle to Reconnect," and subtitled, "Medical reservists return, changed indelibly by war."  It profiles four of the 450 members of the 399th Combat Support Hospital, a Massachusetts-based Army Reserve battalion made up of citizen soldiers who normally serve a weekend every month.  Says the Globe, "In 2006, the 399th was mobilized for a year of full-time duty in Iraq, where the medics often came under mortar and rocket fire as they treated more than 30,000 US and Iraqi forces, contractors, civilians, and detainees."  The battalion returned home on October 1st, and like the men of the 1st Battalion, 25th Marine regiment profiled by the Globe earlier, some, as expected, have had trouble readjusting to life after war.  As the Globe aptly said about those troops, "those who came home have struggled to come to terms with the fact that 11 did not; that 68 others suffered combat wounds; and that many more were hit with injuries less visible but with long-term effects..."

Editor's Note: For more coverage on New England's own, click here and here.  For more blog entries about caring for the caregivers and compassion fatigue, click here.

Study Suggests Some Brain Injuries Reduce the Likelihood of Post-Traumatic Stress Disorder

A new study of combat-exposed Vietnam War veterans shows that those with injuries to certain parts of the brain were less likely to develop post-traumatic stress disorder (PTSD). The findings, from the National Institutes of Health (NIH) and the National Naval Medical Center, suggest that drugs or pacemaker-like devices aimed at dampening activity in these brain regions might be effective treatments for PTSD.

PTSD involves the persistent reliving of a traumatic experience through nightmares and flashbacks that may seem real. Twenty percent to 30 percent of Vietnam vets (more than 1 million) have been diagnosed with PTSD, and a similar rate has been reported among Hurricane Katrina survivors in New Orleans. Public health officials are currently tracking the disorder among soldiers returning from Iraq. Yet, while war and natural disasters tend to call the greatest attention to PTSD, it's estimated that millions of Americans suffer from it as a result of assault, rape, child abuse, car accidents, and other traumatic events.

Previous studies have shown that PTSD is associated with changes in brain activity, but those studies couldn't determine whether the changes were contributing to the disorder or merely occurring because of it.

Jordan Grafman, Ph.D., a senior investigator at the National Institute of Neurological Disorders and Stroke (NINDS), part of NIH, turned to the Vietnam Head Injury Study (VHIS) to make that distinction. The VHIS is a registry of Vietnam veterans who sustained penetrating brain injuries (which are less common in Iraq compared to concussion brain injuries). It has received support from the Department of Defense, the Department of Veterans of Affairs and NIH, and is currently supported by NINDS.

"If we could show that lesions in a specific brain region eliminated PTSD, we knew we could say that the region is critical to developing the disorder," says Dr. Grafman. The results of his study appear online today in Nature Neuroscience.

Dr. Grafman and members of his lab, including neuropsychiatrist Vanessa Raymont and postdoctoral fellow Michael Koenigs, studied 193 veterans registered with VHIS and 52 veterans with combat exposure but no head injury. The participants were classified as either having developed PTSD at some point in their lifetime or having never developed PTSD. CT (computerized tomography) scans were used to map their brain injuries.

By comparing the distribution of brain injuries between the PTSD group and the non-PTSD group, the researchers found two regions where damage was rarely associated with PTSD: the amygdala, a structure important in fear and anxiety, and the ventromedial prefrontal cortex (vmPFC), an area involved in higher mental functions and planning.

In another level of analysis, the researchers compared the prevalence of PTSD in subjects who had damage to either the amygdala or vmPFC, subjects who had damage to other parts of the brain and non-head-injured subjects. PTSD occurred in a similar fraction of subjects in the last two groups — 40 percent and 48 percent, respectively. In contrast, PTSD occurred in only 18 percent of subjects with damage to the vmPFC and zero (out of 50) subjects with damage to the amygdala. The occurrence of other anxiety disorders was not affected by damage to the amygdala or vmPFC.

"It appears that if you have damage to either of those areas, you're not likely to develop PTSD," says Dr. Grafman. The scientists hypothesize that drugs designed to inhibit the activity of the two structures might provide relief from PTSD. Deep brain stimulation, a technique used to treat Parkinson's disease by modifying the brain's electrical activity, might also prove useful against PTSD if targeted to the amygdala or vmPFC.

Current treatments for PTSD include medications for anxiety and depression, and therapy to help the person confront and deal with traumatic memories. But these treatments vary in effectiveness, a point underscored by the fact that many of the Vietnam veterans in Dr. Grafman's study are still dealing with PTSD some 40 years after the war.

Since the study examined only young men who served in Vietnam, one question is whether the results will extend to women, children, or people exposed to traumatic situations besides wartime combat. Dr. Grafman says similar results probably will be found in those other populations, given that previous studies had connected PTSD to changes in the amygdala and vmPFC, and only some of those studies involved war veterans.

NINDS (www.ninds.nih.gov) is a component of the National Institutes of Health (NIH), and is the nation's primary supporter of biomedical research on the brain and nervous system.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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Reference:
Koenigs M, Huey ED, Raymont V, Cheon B, Solomon J, Wasserman EM and Grafman J. "Focal Brain Damage Protects Against Post-Traumatic Stress Disorder in Combat Veterans." Nature Neuroscience, published on-line December 23, 2007.

"The Hell Where Youth and Laughter Go" -- Young Veterans Suicide in War Poetry

Troubling as the rash of young veteran suicides is, and we need to be extremely troubled by it as a nation -- troubled enough to fundamentally believe that there's a problem that needs fixing -- and it isn't the veteran, but how he or she is treated as expendable by the same system that sends them to war -- here's a wonderful poem by one of the famous WWI war poets, Siegfried Sassoon, that speaks to the essence of the topic:

"Suicide in the Trenches"

I KNEW a simple soldier boy
Who grinned at life in empty joy,
Slept soundly through the lonesome dark,
And whistled early with the lark.
In winter trenches, cowed and glum,	5
With crumps and lice and lack of rum,
He put a bullet through his brain.
No one spoke of him again.     .    .    .    .
You smug-faced crowds with kindling eye
Who cheer when soldier lads march by,	10
Sneak home and pray you’ll never know
The hell where youth and laughter go.

--Siegfried Sassoon (1886–1967).  from Counter-Attack and Other Poems.  1918.

Editor's Note: For a link to Sassoon's poetry on Amazon, click here.  We will also increasingly be listing the work of war poets in a book sidebar as they're mentioned or discussed (see right hand side of page).   Oh, and P.S. -- no ageism intended or implied.  The suicide of older veterans is also tremendously troubling.  Each life taken is a profound loss to society, whether old or young.

Young Veteran Suicide Honored

Military.com has a story today about an AMVETS post in Minnesota being named in honor of a young combat veteran who took his own life.  As extremely tragic as the needless death of Army Specialist Noah C. Pierce was, at the oh so young age of 23, the "good" that comes from this event -- the naming of the AMVETS post -- is that it succeeds in taking some of the cultural sting out of this topic, and expands the reach of the concept we so need to hear as a nation, that not every combat-related death ends on the battlefield.  Many stretch past that into civilian life, as vets attempt to integrate and recover from what they've seen, done and experienced.  And their deaths should be no less honored by their communities and their country.

Editor's Note: ABC affiliate WDIO has a good article on Noah Pierce's mom's efforts to get his story out there.  Click here for that link.

What They Found in the Wastebasket

The McClatchy newspapers continue their great series about whether and how the VA system is serving, or under-serving, returning combat veterans with PTSD.

In their recent story, "Suicide Shocks Montana into Assessing Veteran's Care," which by the way is an excellent fact-filled article, there is this troubling mention about what Chris Dana's dad found in his wastebasket, after Chris shot himself last March.  Let's let the McClatchy papers tell the story:

HELENA, Mont. — Chris Dana came home from the war in Iraq in 2005 and slipped into a mental abyss so quietly that neither his family nor the Montana Army National Guard noticed.He returned to his former life: a job at a Target store, nights in a trailer across the road from his father's house. When he started to isolate himself, missing family events and football games, his father urged him to get counseling. When the National Guard called his father to say that he'd missed weekend duty, Gary Dana pushed his son to get in touch with his unit. "I can't go back. I can't do it," Chris Dana responded.

Things went downhill from there. He blew though all his money, and last March 4, he shot himself in the head with a .22-caliber rifle. He was 23 years old.

As Gary Dana was collecting his dead son's belongings, he found a letter indicating that the National Guard was discharging his son under what are known as other-than-honorable conditions. The move was due to his skipping drills, which his family said was brought on by the mental strain of his service in Iraq.

The letter was in the trash, near a Wal-Mart receipt for .22-caliber rifle shells.

All across America, veterans such as Chris Dana are slipping through the cracks, left to languish by their military units and the Department of Veterans Affairs.

It's implied, but not stated, that Chris Dana might have been driven to suicide by the one-two punch of PTSD and then being discarded by his own unit as unfit to serve (and therefore to collect benefits).  The timing is certainly...troubling.  It's a heartbreaking story, and it wouldn't be surprising if it is, in many ways, being played out all across America, as returning veterans struggle with their own private demons -- grief and loss and trauma, from combat -- and find a system that not only doesn't embrace them, but makes it difficult for them to find the care they desperately need, when they need it.  In Chris Dana's case, the system created more difficulties for him -- not helped him deal with the difficulties he already had.

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I've read a lot of stories by now about young veterans killing themselves, and my sympathies are really with them.  Not instead of the veterans who, battling their own demons as well, end up harming others, sometimes but not always before harming themselves.   One common thread to the stories where young vets take their lives is they often are aware that they have a problem, but the timing is bad about getting help.  They, and their families, are often aware that something is wrong -- Johnny went off to war but didn't come back the same sweet, fun-loving guy who left -- but the drag is, they can't get in to get seen in enough time by competent mental health professionals.  There's often an unconscionable wait to be seen at the VA.  And of course they're often also pretty well-mired in the not-exactly-advantageous experience of self-medication with drugs or more commonly, alcohol -- to keep the demons at bay.

So they don't get seen in time enough, even though everyone knows something's desperately wrong, and the next thing you know, they're dead, and they're leaving families who are quite shell-shocked themselves by the double horror of having their child come home from war a substantially different person, and having them take their own lives, often in the family home.  There's such a list by now, of callow young men, deep in a struggle with combat trauma, not getting the timely help they need, and dying by their own hands, leaving anguished families in their wake.  Joshua Omvig, Jason Cooper, Jeff Lucey, Noah Pierce, Chris Dana, the list literally rolls on...120 a week.

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It's becoming apparent that PTSD is, in many ways -- except for the possibility of windfall payout -- a real lottery.  It's a lottery whether you'll get it -- not everyone who goes to or through combat, does.  It's a lottery when it will  happen -- it often shows up a delayed interval after combat, not immediately (immediately would be more convenient for everyone).  (In fact, it can show up many years -- as in, decades -- later.  That's why you see Vietnam-era vets finally realizing they have it, as they reprocess their own trauma in sync with veterans coming back from Afghanistan and Iraq.)

There are a few more lotteries, though.  It's a lottery whether the VA will know how to treat you -- you'd be unhappily surprised if you saw the searches various VAs do on this very blog.  Doesn't exactly inspire confidence that they know the direction to go in; seems quite a bit more like they're clutching at straws.  It's also going to be a lottery whether you'll get evaluated in a competent way, and ascribed the correct percentage of disability.  News reports lately, particularly from the McClatchy Newspaper chain, which did its own independent research, show that VAs vary widely from state to state in terms of how they confirm or compensate PTSD in their centers.  (We blogged about it, here.)  It's also a lottery whether the military will even see your case of PTSD for what it is; because it might create behavior problems that they start to see as failures in discipline, and demote or discharge you because of it (as they did in Chris Dana's case), and then you really won't be in a position to pay for your own care.  And of course, it's really a lottery to see if your family, community, job, and social network will embrace you, accept you, or reject you. (It won't have much to do with your own worth; more to do with them, but no matter.  It'll still hurt.)  Then there's the lottery of whether you'll be able to afford to live on the meager proceeds of your disability pay, should you be "lucky enough" (there's the lottery concept again) to receive any.  And the true, ultimate lottery of whether you'll end up becoming homeless -- a good one quarter of homeless males in America now, and the figure stands to go much higher, has been show to be veterans, many of whom have PTSD.

And of course there are also the lotteries of whether you'll become addicted to drugs and alcohol, in your quest to cope with the pain and self-medicate, either while you're waiting around for the VA to see you and/or take your case seriously, or, just because it's a socially-acceptable option that's within easy reach, and in some ways more instantly accessible than dealing with the ups and downs and unknowns of medications offered.

The only problem with all these lotteries? (and they are gambles, after all...)   No positive payout.

I'm beginning to think, as I read story after story in the press of hapless veterans colliding with a system that doesn't care, and harming themselves or others, or just plain checking out, when they've reached the wall and can't find, or get, help for their suffering -- that the only "lottery" I know that resembles this is a very famous one indeed.  "Survival of the fittest," a phrase that came to prominence with Charles Darwin, and the concept of natural selection.  Only the very strongest can survive: the sick, the weak, the ailing, all fall behind and get taken out.  Combat trauma -- a very natural reaction to very unnatural events -- weakens those it affects.  And the system, such as it is, exemplified by the VA -- doesn't really stand ready to help in any pro-active, instantaneous, constructively helpful way.  Not to mention, it's almost impossible for those traumatized to simultaneously also aggressively advocate for their own care.  So the veterans who are struggling with trauma are weakened, and the system picks them off, one at a time -- by attrition, if not by outright neglect.  I think that's why you see some Vietnam-era veterans jumping in to do what they can to help young vets just coming back.  They literally don't want to see today's crop of veterans have to struggle as long or as hard as they've had to for the care that they need. I applaud the heart behind those vets' efforts, but at the same time I'm discouraged that, if PTSD is a lottery, we can't have a care system based on natural selection -- where only the strongest can survive its delays and haphazard care.

NOTE: Callow -- it's not an insult, it's a description.  It means, lacking adult maturity or experience.  Which sometimes allows you to put into perspective that whatever you're going through is not worth killing yourself over.  Sometimes, but not always.