Healing Combat Trauma

Not an April Fool's Joke: Vietnam Vet Just Received Compensation for His PTSD Claim

The Wadena Pioneer Journal of Wadena, Minnesota, published a story recently, touting the eventual -- and I do mean, eventual -- "victory" of a Vietnam-era veteran receiving compensation for his PTSD.  That's the pioneering Eugene Foster himself, in the photo at left.  Minnesotans must be made of very strong, enduring stuff, because Mr. Foster has persisted through a two and a half year claims process, and three appeals, to achieve his victory of $65,000, or $2,527 a month from Veterans Affairs for the rest of his life, according to the story.  The article also quotes Mr. Foster as saying, "I don’t give up too easy...I come from a long line of stubborn people."  Good thing, considering the Vietnam war ended 33 years ago next month, and, at 64, Mr. Foster's life expectancy is just 15 more years, a number probably discounted further by years of poor health.  Ever alert for a touch of irony in these heart-breaking situations, I find it in this comment of his veterans service officer: "“The only thing I can say is the system works.”

Well, provided you're not in any hurry, I guess.  Mr. Foster had another claim out, according to the paper, for "continuing knee problems he said stem from a shrapnel wound he sustained during the Tet Offensive in January, 1968."  But, he "dropped that claim during the process of receiving his PTSD settlement, he said."

Like the narrator in Langston Hughes' poem, "Mother to Son," who lamented that "life for me ain't been no crystal stair," Mr. Foster has had, arguably, more than his share of suffering and pain in this lifetime,  much of it thanks to his Vietnam experience, and his attempts to cope with that through his own methods and means.  The article in the Wadena Pioneer Journal is brief, but it mentions about a dozen difficult life experiences.  A brief catalog of this veteran's hard luck life: the Vietnam War itself, PTSD, his Vietnamese fiancee killed by the Viet Cong; the shrapnel wound; the knee problems; the lifetime spent self-medicating his depression with alcohol, till he kicked that habit; high blood pressure; and getting around in a walker and a wheelchair, in an apartment that had stairs.   Thankfully, Mr. Foster persisted, and now the small settlement will allow him to move apartments, and ideally be able to find a "two-bedroom condominium with all new carpets, floor heating and dishwasher..."  Small, reasonable goals for someone who served his country, honorably.  As Mr. Foster cautions others veterans, "Fight, don't give up."  Veterans "deserve what compensation they get." (We won't argue with that.  They even deserve it in a timely fashion, and enough to live on.)  As he says, "A lot of people should be compensated who don't have it."

Editor's note: Click this link to find the article.  The original article on the Wadena Pioneer Journal's website has some technical difficulties accessing it.

"Silent Majority" of Vets Not Seeking Help...Yet

The Virginian-Pilot has an excellent article in today's paper, talking about a recent, regional conference of social workers and others who met to address concerns of troops coming back from Iraq and Afghanistan, and the services they will require.  Click here for a link to that story, entitled, "Conference at Fort Monroe Touts Medical Resources for Vets."  The regional conference was put on by a program called, "Virginia is for Heroes," and it seems to have covered a lot of ground. 

Navy commander and psychologist, Beverly Dexter, Ph.D., spoke, as did several others, including Harold Kudler, a VA physician and mental health services manager.  (See our profile of Beverly Dexter, Ph.D., linked here.  Dexter will also be speaking at the Washington State Psychological Association's annual seminar on April 11th and 12th in Seattle.  Click here for a link to that story.)  According to Kudler, referencing Vietnam veterans, the trend is for one-third of veterans with PTSD to seek help from the VA; the other two-thirds apparently seek help elsewhere (including those who don't seek help at all?).  Among current veterans, the trend seems to be, 37% of those eligible have sought treatment from the VA, for all health conditions, not just psychological help. 

Kudler and others wonder where the other 63% are going -- the so-called "Silent Majority," who may be suffering less visibly.  The implication, according to the article, referencing Kudler, is that "this “silent majority” of recent combat veterans may turn to other sources for help – churches, family doctors, community service boards – that need to be prepared to assist them."  Apparently Beverly Dexter, Ph.D., and others believe the abundance of community mental health providers and resources is sufficient as is -- but effort may need to be made to link those in need with the resources available.  Educational outreach by the VA to veterans and veterans' families, as we've reported on recently, seems to be part of the solution.  Good article about progress being made.

Editor's note: for a link to "Virginia is for Heroes," click here.

Raymond Monsour Scurfield, DSW, ACSW, LCSW

Dr. Scurfield is Professor of Social Work, Director of the Katrina Research Center and President of the Gulf Coast Faculty Council, University of Southern Mississippi Gulf Coast.  He was the 2006 Mississippi NASW social Worker of the Year for his post-Katrina efforts, and he continues to provide counseling at the University of Southern Mississippi Gulf Coast to students, faculty and staff. His MSW and DSW are from the University of Southern California.  He was a social work Army officer on a psychiatric team in Vietnam (1968-69) and has co-led return trips to peace-time Vietnam in 1989 and 2000.

Previously, Dr. Scurfield had a 25-year career with the Department of Veterans Affairs in which he directed several regional and national Post-traumatic Stress Disorder (PTSD) programs from Washington, DC to Tacoma, WA, to Hawaii and American Samoa. He has over 60 publications, has been PI or Co-PI in several PTSD research studies, has given over 350 presentations in the U.S. and abroad and has made numerous media appearances, to include 60 Minutes, Nightline, Nightwatch, National Public Radio and numerous NPR-affiliated radio stations nationwide. Dr. Scurfield has been active in post-disaster interventions and is a certified Compassion Fatigue Educator and Compassion Fatigue Therapist. Dr. Scurfield’s most recent writings are about post-Katrina interventions on the Mississippi Gulf Coast. His November, 2004, book was the first book in a series, A Vietnam Trilogy. Veterans and Post Traumatic Stress, 1968, 1989 & 2000. The second and third books in the trilogy were published in 2006: Healing Journeys. Study Abroad with Vietnam Veterans, and Volume 3, War Trauma. Lessons Unlearned From Vietnam to Iraq that describes over 30 unlearned lessons about war, its impact and what to do about it.

To download Prof. Monsour's CV, click Download raymond_monsour_scurfield.doc .

Behind the Bloodshed, Some Backstory

Another day, another lurid headline.  A Marine Lance Corporal in Texas, recently returned from three back-to-back tours of duty in Iraq, and allegedly suffering from PTSD, breaks into his former girlfriend's home, stabs her to death and then waits, "covered with blood and looking dazed," in the parking lot for police to arrive and arrest him.  On the surface, another brutal domestic violence story, with a very tragic ending.  Behind the headlines, though, more questions than answers about troops' after-care, and whether ethnicity (the Marine in question is Hispanic) plays or ought to play a part in how PTSD is diagnosed and treated.

First, some facts.  Marine Lance Corporal Eric R. Acevedo, 22, was arrested over the weekend for allegedly murdering his former live-in girlfriend, in Saginaw, Texas, a suburb of Fort Worth.  The Fort Worth Star-Telegram has been covering the story, and it's typically gruesome, but it's also a tragedy for all concerned. The victim, who was a single mother; the alleged perpetrator, who will likely do substantial prison time; and both people's families -- the 10 year old girl who now grows up motherless, as well as Acevedo's family, who believed he was struggling with PTSD, but was sent back to Iraq.

There are several items that stand out immediately from this story.  One is the obvious: three tours in Iraq by the time you're 22?  Wow.  That's a lot of compressed heavy living right there, at a very young age.  (Acevedo joined the Marines just a few days after graduating from high school.)  Another is obvious from the photos that run with the story.  There's one of Acevedo in his dress blues, looking fit and tanned and what they call in language of the personal ads, "height-weight proportional."  Then there's his booking photo, where he looks, oh, about 44, not 22, and seems heavy, puffy and bloated.  It doesn't even look like the same person.

Then there are the comments from his family, which underscore that to them, Acevedo wasn't the same person anymore.  (Granted, those have to be taken with a grain of salt, because, after all, they're coming his family.  But still, listen to what they have to say.)  The following quotes are from the Star-Telegram.  His aunt: "I know he was a good soldier. I just don't know what happened. When he went in, he was so proud. When he came out, he had so many problems. I don't know what happened to him."  His dad, who feels that his son has never been the same since his second tour of duty in Iraq: "I gave him to the government nice and healthy, and the government returned somebody who is capable of doing something like that...I'm out of words as far as to just how sorry I am."

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In the Marine Corps, Lance Corporal Acevedo did three tours of Iraq over four years' time, returning for the last time 13 months ago, and leaving active service to go into the Individual Ready Reserve.  According to a Marine spokesman quoted in the article, Acevedo had been stationed at Twentynine Palms, California, "and was deployed for about seven months in 2004 and again in 2005-06, and for six months in 2006-07." The Marine spokesman says Acevedo was "a good Marine," and received various medals for his service, including the Marine Corps Good Conduct Medal, Navy and Marine Corps Achievement Medal, Iraq Campaign Medal, Global War on Terrorism Service Medal, Global War on Terrorism Expeditionary Medal, National Defense Medal and Combat Action Ribbon.

But according to at least his parents, something drastic happened to Acevedo between his second and his third tour of duty.  Says his father, "I was very proud of him. He served well over there. He never complained.  But when he did this last tour, he was feeling kind of like he didn't really want to go because of the nightmares and stuff he had had from the second time. My wife tried to stop it over medical issues. They still sent him off."

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Because it's always worthwhile to find out if there's any backstory worth knowing, I did a little digging.   What had Acevedo experienced that might have caused the change in his behavior?  Deep within the archives of the Marine Corps' own website, there's a wonderful, even iconic photo of a grieving Lance Cpl. Acevedo, grasping someone who's identified only as a young relative in an emotion-filled hug.  The occasion is a memorial service to commemorate the 13 lives lost by Acevedo's battalion, 10 of them on a single day in Fallujah, making that one of the largest losses of American life in the Iraq War.  Acevedo served on that tour with the 2nd Battalion, 7th Marine regiment, also known as "the War Dogs."  On December 1, 2005, ten of his brother Marines died in an IED blast while out on patrol.  While all lives lost are precious, and close-knit groups like the Marines feel every loss deeply -- one wonders, is it harder to endure large losses at once, than multiple losses, individually?  Has this even been studied?  (Seemingly not.)  One thing is sure: studies show that the more traumatic incidents a person is exposed to, the greater the likelihood that they will develop PTSD.

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From what his father says, reported by the Fort Worth paper, Lance Cpl. Eric Acevedo wasn't coping so well anymore.  Six months ago, a military doctor "diagnosed his son with post-traumatic stress disorder and placed him on medication that seemed to calm him down."  But there's some dispute about whether those facts were strictly true. The paper also reports that, according to records kept by the Dept. of Veterans Affairs, Acevedo had "not enrolled enrolled in the VA North Texas Health Care System or applied for any VA benefits."  So time will tell which of these stories are true.  But one thing is certain: If Acevedo really did have diagnosed PTSD, at the end of his second tour (after the Fallujah incident), it wasn't a good idea to send him back so quickly for a third deployment, if at all.

And then there are other implications.  The multiple tours and long deployments, with insufficient breaks in between tours, all recent news reports indicate, seem to be wearing troops out, not just the Marines.  (See discussion in today's Military Times.)  Even the Dept. of Veterans Affair's own data shows that when it comes to PTSD (this data is based on Vietnam veterans), "higher levels of war-zone exposure tend... to contribute to a higher degree of symptoms."  (Longer tours and more of them certainly constitute higher levels of war-zone exposure.) 

In addition, the same study showed that "race/ethnicity appeared to be an important risk factor, as African-American and Hispanic Vietnam veterans tended to report more mental health and life adjustment problems. For PTSD in particular, Hispanic male veterans had the highest prevalence rate..."  Not to argue for preferential treatment for various ethnic groups, but, shouldn't the implications of this data at least be acknowledged?  Maybe PTSD is affecting different people differently, even if we don't know all the reasons why yet.  (There are other implications, too, about medications that purport to solve some problems while increasing risks of others; and the jagged line where domestic violence and PTSD can intersect, with often tragic consequences -- but we'll have to save both those discussions for another time.)

Editor's note: The Marine Corps story about the memorial service for Acevedo's battalion is linked here.  The list of Marines who died on 12/1/05, according to Marine Corps sources, are as follows: Staff Sergeant Daniel J. Clay, 27, of Pensacola, Florida; Lance Corporal John M. Holmason, 20, of Suprise, Arizona; Lance Corporal David A. Huhn, 24, of Portland, Michigan; Lance Corporal Adam W. Kaiser, 19, of Naperville, Illinois; Lance Corporal Robert A. Martinez, 20, of Splendora, Texas; Corporal Anthony T. McElveen, 20, of Little Falls, Minnesota; Lance Corporal Scott T. Modeen, 24, of Hennepin, Minnesota; Lance Corporal Andrew G. Patten, 19, of Byron, Illinois; Sergeant Andy A. Stevens, 29, of Tomah, Wisconsin; and Lance Corporal Craig N. Watson, 21, of Union City, Michigan. All 10 Marines died December 1, 2005, from an improvised explosive device while conducting combat operations against enemy forces in Fallujah, Iraq. All 10 Marines were assigned to 2nd Battalion, 7th Marine Regiment, 1st Marine Division, I Marine Expeditionary Force, Twentynine Palms, California; During Operation Iraqi Freedom, their unit was attached to 2nd Marine Division, II Marine Expeditionary Force (Forward).

Women Veterans and Military Sexual Trauma

A study reported in the Journal of General Internal Medicine in 2006 compared rates of Post-Traumatic Stress Disorder (PTSD) in female veterans who had Military Sexual Trauma (MST) with rates of PTSD in women veterans with all other types of trauma.  (The full title of the article is "DSM-IV Diagnosed Posttraumatic Stress Disorder in Women Veterans With and Without Military Sexual Trauma.")

Women subjects were recruited via health appointments and/or a mailing, and completed questionairres about their military service and their health and trauma history.  The results were shocking: Ninety-two percent (92%) reported at least one (1) trauma. Forty-one percent (41%) had experienced MST, either alone or with other trauma, and 90% had other trauma, with or without MST. Overall, 43% of subjects with trauma had PTSD. And most importantly, those women veterans who had endured military sexual trauma had higher rates of PTSD.  Sixty percent (60%) of those with MST had PTSD; 43% of subjects with other traumas (with or without MST) had PTSD. Military sexual trauma and other trauma both significantly predicted PTSD in regression analyses (P = .0001 and .02, respectively) but MST predicted it more strongly. Prior trauma did not contribute to the relationship between MST and PTSD.

The study concluded, "Findings suggest that Military Sexual Trauma (MST) is common and that it is a trauma especially associated with PTSD."  To read the article itself, click here.  (The citation for the study is: J Gen Intern Med.  2006;21(S3):S65-S69.)

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(Quoting from the study):

Rape is a violent crime with long-lasting consequences that is often perpetrated against women. At particular risk are women working within male-dominated environments such as the Armed Services, which, despite a recent influx of women, continue to be composed mainly of men.

National surveys found 13% to 30% of women veterans experienced rape during their military service. What is only beginning to be understood is the long-term impact that military sexual trauma (MST), such as rape, has on the lives of women veterans.

Posttraumatic stress disorder (PTSD) is one of the known consequences of rape. In fact, rape is the trauma most highly correlated with the development of this disorder. Posttraumatic stress disorder associated with rape is long lasting. Further, PTSD itself can cause impaired physical and social functioning. Most of what is known about rape and PTSD comes from the literature on civilian sexual trauma. Much less is known about the relationship between PTSD and MST. Previous studies examining the link between PTSD and MST have identified symptoms suggestive of PTSD or have created models connecting MST with the development of PTSD.

There is only one (1) study, to our knowledge, that examined rates of DSM-IV PTSD diagnoses in women veterans with MST. Suris et al., using a sample of female Veterans Administration (VA) patients, compared rates of PTSD related to 2 types of civilian sexual trauma with PTSD rates related to MST. They found that MST was more frequently traumatizing than civilian assault. Thus, the literature indicates that MST is more predictive of PTSD than are other types of military trauma or civilian sexual trauma.

Darrah Westrup, Ph.D.

Darrah Westrup, Ph.D., is a clinical psychologist living and working in the San Francisco Bay Area. She received her degree from West Virginia University and completed two years additional training in behavioral medicine at the Department of Psychiatry and Behavioral Sciences at Stanford University Medical Center. She is currently working as attending in the Women's Trauma Recovery Program at the National Center for PTSD, and is the program director of the Women's Mental Health Center, VA Palo Alto Health Care System. Westrup also maintains a private practice based in Menlo Park, CA. She has clinical and research expertise in the areas of PTSD, substance abuse, stalking behavior, and experiential avoidance as it relates to psychological dysfunction.

Darrah Westrup, Ph.D., is one of the co-authors of Acceptance & Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder: A Practitioner's Guide to Using Mindfulness & Acceptance Strategies.  Oakland, CA: New Harbinger Publications (2007).

Women's Mental Health Center ("WMHC") for Women Veterans

The VA Palo Alto Health Care System (VAPAHCS), widely recognized for its innovative treatment and research pograms, introduced the Women's Mental Health Center (WMHC) in October, 2002.

The Center was created in recognition of women veterans and their right to gender-sensitive, high quality mental health care.  The Center's mission, to promote the psychological well-being of women veterans, is advanced via provision of individual and group therapy, and delivery of psychoeducational classes and seminars developed in response to the unique needs of the women we serve.  A few important links:

• The Women's Mental Health Center Home in Palo Alto, CA, linked here.
• A gallery of photos showing the campus and typical attendees, linked here.
• A brochure about the program, downloadable as a PDF, linked here.

National Women's Trauma Recovery Program ("WTRP") for Women Veterans

More than a decade ago, the Department of Veterans Affairs opened the National Women's Trauma Recovery Program (WTRP) as part of the National Center for PTSD at Menlo Park, CA. The WTRP, designed to treat women veterans with post traumatic stress disorder (PTSD), is the first residential program of its kind and is open to women across the country. Many of the women who are referred to the program were sexually assaulted during their military service and suffer what is now referred to as Military Sexual Trauma (MST). The WTRP is intensive 60-day residential program with a strong emphasis on interpersonal skills. The initial two weeks of treatment involve psychological and psychosocial assessments in order to develop comprehensive treatment plans. Women come into the program in classes, or cohorts, and work together to problem-solve, learn effective communication, and better manage their PTSD/MST symptoms.

Here's a list of key links:

• An overview of the Women's Trauma Recovery Program (WTRP), linked here.
• A statement about who's eligible to attend, linked here.
• The application itself, linked here.

The WTRP progam is headed by Darrah Westrup, Ph.D.  She has some positive, uplifting things to say about the program itself, including this quote: "our program is all about helping women reclaim their sense of worth and personal power." For more of her remarks, click here.  For more about Darrah Westrup, Ph.D., click here.

Special VA Programs Geared to Women Veterans

It's a little late for International Women's Day (March 8th) and a little early for Mother's Day (May 11th), but it's time to talk about the special needs and concerns of women warriors, and how they're affected by combat trauma.  The most recent issue of the Disabled American Veterans' magazine has an article on women combat veterans.  The public service poster graphic in particular (see left) is impressive, as is its slogan: "War is Hell: Being a [Woman] Veteran Shouldn't Be."  Click on this link to download the March/April issue as a PDF; the article begins on page 19.

It's good news that the VA is becoming more attuned to the special needs of traumatized women veterans, either through PTSD or sexual trauma, or both.  Here's a section of the main VA website that addresses VA Programs for Women Veterans.  Click here for that link.  The programs cover several important areas, including mental health and sexual abuse counseling; medical services for women veterans; education and training; research; compensation for women veterans; national cemetery administration; and demographic trends.  According to the VA's own website, women veterans should be able to get help by contacting the nearest VA center, and asking to speak to the women's program manager, who will be able to refer them to the right help.  To review the briefly-noted information on the VA website, click here.

There's also a physical facility at the VA Palo Alto Health Care System devoted to women's recovery from trauma, both combat trauma and military sexual trauma (MST).  That program is known as Women's Trauma Recovery Program, or WTRP, and it's housed in a facility, called the Women's Mental Health Center Home.  This program is open to women from all wars, with programs being developed to focus on OEF/OIF veterans.  For more from the VA about women veterans with MST, click here.

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Statistically speaking, according to the VA:

The estimated population of women veterans as of 2001 was 1.6 million, or about 7.2 percent of the total veteran population.  10.26% of the 22.8 million veterans who use VA for healthcare are women.  Currently, women make up 14.8 percent of the active duty military force and approximately 22.8 percent of the reserve force.  By 2010, they are expected to represent over 14 percent of the total veteran population.  Fifty-six percent of women veterans who use VA are less than 45 years of age.  Sixty-two percent of women veterans are less than 45 years of age.

When it comes to women veterans and Military Sexual Trauma, though, the figures are worse.  We've done a blog post about that separately.  To read that, click here.

Making a Fractured Heart Whole Again - Military Sexual Abuse and Women

The Buffalo News has an excellent feature story in today's paper about a residential program at the VA for women who are survivors of military sexual abuse, among other forms of trauma.  The residential program profiled in Batavia, NY is one of four such programs the VA runs in the country.  Others will be profiled in future blog posts.  The article is entitled, "Female Veterans Find Help with Emotional Wounds at Batavia Facility."  Go here and read the story.  For a somewhat generic link to the VA's position on women veterans with military sexual trauma (MST), click here.  For a link to the actual VA residential program for women veterans in Batavia, NY, mentioned above, click here.

On the West Coast, there is the Women’s Trauma Recovery Program (WTRP), opened by the Palo Alto, CA VA in 1992 as part of the National Center for PTSD. It is an intensive 60-day residential program with and emphasis on interpersonal skills and a focus on war-zone related stress as well as MST (Military Sexual Trauma).  For a link to a blog post discussing that in greater depth, click here.

There's also a residential program for women at the VA in Tyler, Texas.  And apparently there is a fourth program as well, but an hour plus surfing the VA's inscrutable website doesn't clarify where that is.  When I find out, I'll include the information.  For a link to the Central Texas program, click here.

Helping Families to Recognize Veterans' PTSD

The Northern California news website, InsideBayArea.com, has a good article in today's edition, entitled, "Families Can Help Spot Vets' PTSD."  Click here for the link.  The article quotes Byron J. Wittlin, M.D., Director of Mental Health Services at the VA Clinic in San Bruno, CA.  Says Dr. Wittlin, "I think it's crucial for (military) family members to be aware of the potential mental health problems of their loved ones."  It's great to see the VA doing outreach to family members, who are in a unique position to see for themselves veterans' difficulties readjusting to life after combat.  (For a very good video about veterans, PTSD, and readjustment issues, click this link to an earlier blog post, where we highlight the "PTSD and Veterans: Beyond the Yellow Ribbon" video put together by the Norfolk County District Attorney's office, in Canton, Massachusetts.)

The article covers some important topics, including typical PTSD symptoms, veterans' reluctance to seek care, the perceived stigma surrounding mental health issues, and whether or not a loaded gun is wise to keep in the house.  Wilkins offers some hope about PTSD, that sufferers can get better.  And while he acknowledges that it takes a trained expert to actually diagnose PTSD, family members can play an important role in moving that process along, and encouraging their veteran to get help.  According to the article, "We encourage family members to be supportive, to mainly listen," Wittlin said. "And if they feel the vet needs some help, to call the VA and to refer them into us. This is really a complicated problem. And in our system, we have a lot of experience. And this is one of the services we want to offer."  Excellent news, for veterans and their families.

Editor's note: The Dept. of Veterans Affairs facility in San Bruno, CA is linked here.

Proposed "Veterans Village" Gets the NIMBY Treatment from Its California Neighbors

Yahoo News reported recently on the stalled-out progress of the privately funded "Veterans Village" proposed for Guerneville, CA.  (Guerneville is a small resort town located in Northern California's Sonoma County, famous for its vineyards, redwoods and tourism, among other things.)  The Veterans Village has been the brainchild of gold star mom, Nadia McCaffrey, who conceived it as a way to honor her son's death in Iraq.  We've blogged about the project earlier: click here for the link.  The Associated Press article that Yahoo published is called "Group Housing for Vets Raises Concerns," and it's linked here. 

Apparently Sonoma County's building inspector has called a temporary halt to construction, and skittish neighbors are voicing their fears.  Sounds like another case of NIMBY: great idea, but "Not In My Back Yard."  Realistically, the public is still in the process of getting educated about what PTSD is, and the prospect of transitional housing for veterans with PTSD in what amounts to a residential neighborhood, has a few neighbors queasy and reacting.  This may be a project that would work better in a year or two, when the tide of public sentiment moves further towards embracing injured veterans with PTSD.  At the same time, resistance highlights some of the problems with the project.  Advance work about what PTSD is and what to expect from the project -- some of it or MORE of it -- may need to be done in the neighborhood.  And the project's developers, Ms. McCaffrey and others, may need to get more clear about what their project really is, in order to build consensus about it, if any can actually be had.  This project has always seemed a little bit squishy.  Either, not all the necessary aspects have been thought through, to create an aura of confidence in the project; or, just as important, if they have been though through, they may not have been communicated fully.  And squishiness is problematic.  If a project lacks definition or clarity, it's hard to get supporters fully behind, and that much easier for opponents to attack.  Local residents are likely to be way more concerned about their property values than they are about the mental health of combat-traumatized veterans.  And that's not an aspersion, it's a fact.  I want Ms. McCaffrey to be able to honor her son's sacrifice with something meaningful; but I'd also like to see a clear plan set forth that compels participation.  Either that, or fold the project into something else that is making headway.  That old business saw: jump on another bandwagon, if it's at least headed in the same general direction.  I wonder if the anonymous donor gets his gift back if the property can't be developed as planned.

Editor's Note: The Veterans Village project is linked here.  It is an IRS 501(c)(3) charity, so you can donate to it if you're so inclined.  Additionally, Sonoma County, California's official website is linked here.  The Wikipedia entry on the town of Guernville, CA is linked here.

VA Head Peake Talks to Veterans at Local VFW

The tiny Salisbury Post, from Salisbury, North Carolina, has an article in last Friday's paper about the current VA Secretary, James Peake, M.D., meeting with veterans at the local VFW, along with their U.S. senator, Richard Burr.  Click here for the link.  The story is entitled, 'Old soldier' vows to take care of veterans, deal with VA claims backlog," and it's an interesting story to read, mostly from the point of view of wanting to remember, for posterity, what Peake is saying his point of view is regarding veterans.  The article quotes him as saying, among other things, "The idea is to get out and really understand what's going on with the veterans, and how well we're taking care of them."  While that's a laudable sentiment, so far as it goes, it and other quotes like it make Peake sound an awful lot like he's currently on a "fact-finding mission" at the moment, talking with veterans to see how their care is going, and how they and their families feel about it.  And if that's true, it's "nice."  It's a little bit like childhood memories of school principals or maybe even superintendents walking around the lunchroom, asking elementary schoolers who basically had no real vote in the process how they liked what the cafeteria was serving. Somewhat of a pr move, even at the best of times, and if the school were in fact on fire, really not the best use of time, or conversation to be having.

In the present case, it seems that the facts of what's been going on with veterans care have been more than adequately laid out for all to see, and that the process of triaging out the worst problems and starting with fixing them could already be underway.  So I'm not really sure what to think about this.  I want to believe it's sincere, but talking with a few veterans and VA staff at a single VFW doesn't really constitute aggressively going after change.  It's fair to say most of us who've been following this topic with any regularity already have a pretty clear idea of what the issues are.  And here's the thing: there's basically NO TIME TO WASTE, while veterans are dying by their own hands, or taking forever to get in and get appointments to be seen, etc.  There's an old saw in the legal biz that "justice delayed is justice denied," and the same is true here.  The difference between being seen or treated and not can mean the difference between life and death to some veterans.

I understand and sympathize that there's a public relations aspect to any job this big, and Peake is very much a political appointee, not an elected official.  However, to the extent that we can dispense with the fireside chat and start triaging the mess we're in, so much the better.  The public relations aspect might be better left for a window of relatively little activity, in other words, when things seem reasonably fine.  If things are pretty much under control already, then great, get out there and met the vets, and get the scorecard on how things are really going.  But when the scorecard is already in the paper, and is already clear for all to see, it seems like it's more likely a form of not taking things seriously enough.  If my car is up on blocks in the yard, it's really not time to get it detailed, or fuss about how long it's been since I've washed it.  More serious issues are afoot -- with all due respect, let's get ON with it.  There is no shortage of work to do, and veterans to be served, who, with their families, are waiting.

Military Chaplains Carry, and Comfort in, Grief

Yahoo News has a good story today about the role of military chaplains in honoring the sacrifices of servicemen and women who have died in combat.  It profiles the experiences of four military chaplains, who've served in Vietnam, Afghanistan or Iraq.  The article is called, "Chaplains Salute Each of the Fallen," and it's linked here.  As the article points out, "Military chaplains don't carry weapons, don't engage in combat, and yet they know as well as any the human cost of war," and this "human cost" very much takes its toll, even on those most qualified by their faith, so to speak, to offer comfort and support.  Said one chaplain, quoted in the article, with each subsequent death, "you lose part of yourself that you're never going to get back."

Those of us who were raised on M*A*S*H have a probably very skewed view of what chaplains do in wartime, but there's no question that they're a special breed -- needing to be there to offer words of comfort and support to the troops, in the midst of struggling with their own very real grieving over loss.

In related news, congratulations are in order to fellow PTSD blogger, Kathie Costos, for just last week passing the test to become one.  With her extensive, 25 years of personal experience caring about combat trauma and its effects on the troops, as well as her personally offering comfort to those who suffer, she should really be one sensational chaplain.  Kudos to her for a wonderful accomplishment.

Happy Birthday - We're Two!

Happy Birthday to us  - we're two years old!  This blog was started back in February, 2006, with this post, and almost 300 posts later, we're still here, alive 'n kickin'.  That's almost a post every other day.  We've managed to cover a lot of topics, even win a nice award in the process, and be read by people all over the world, including frequent visitors from colleges and universities, the Dept. of Veterans Affairs, the DOD, the Pentagon, the U.S. House of Representatives, the Senate, various major media outlets, including ABC, CBS and NBC, even lately some movie studios.  (Although they're probably looking for references to Rudy Reyes...)  In fact, our readership has increased more than tenfold, just in the last year alone.  And in the first two months of this year, we're on a pace to multiply that by five or six times more.  Other accomplishments we're proud of?  We've built a cool library of veteran-oriented reading material, focused on combat trauma and PTSD, along with first person narratives of war, which are important to read if you want to know what veterans have experienced.  It can't just be head knowledge: it has to be heart knowledge, too.  We've created a group on Facebook for those interested in this topic, as well as a page where you can show that you're a "fan" of this website.  And become friends with some wonderful other bloggers who also cover this territory in able fashion, in particular Ilona Meagher and Kathie Costos. 

In the upcoming months, we want to get back to exploring more of our core purpose of this blog, which is to bring attention to the key medical, psychological and legal remedies for combat trauma, as well as focus on who some of the experts are.  The goal of having this blog in the first place?  That those who suffer from combat trauma will end up being able to find catharsis.  The type of result that involves dealing with it, addressing it, and ultimately, moving through it and beyond it.  And if the injured veteran is in the middle of the concentric circles, the ripples on a pond, that those in the outer rings, from family members, to ultimately, decisionmakers, would understand what combat trauma is -- how to prevent, how to work with it, how to heal it.  And that would be "Healing Combat Trauma," indeed.

If You Build It, They Will Come: Vets and Mental Health Services

I happened to hear an item of interest about veterans on local San Francisco public radio station KALW as I was driving around doing errands.  The show was "Cross Currents," and the story was about going to the VA Medical Center in San Francisco, and how most of the patients are older, gray-haired types from the Vietnam era, and how there are very few veterans showing up from the wars in Afghanistan and Iraq. Even the staff members are trying to figure out why, and they have several theories, including that soldiers don't always realize they're eligible to be treated by the VA, and that those with compound injuries are treated in Palo Alto, CA instead, because it is one of the VA's four polytrauma centers in the U.S.  They were saying that most of the injuries seemed physical; yet, when the opportunity for mental health services were offered, a stunning [to me, maybe also to the providers] 98% of the veterans were interested in a referral.  No transcript has been posted yet on the probably underfunded KALW site, but the reporter's name was something like Joy Corneule.  I'm interested in seeing if anyone can substantiate that figure, because that is plenty interesting indeed. (It also seems abnormally high.)

It would be significant for all kinds of reasons, including increasing public awareness of what veterans have undergone, and decreasing stigma about mental health issues in general, including combat trauma and PTSD.  It also brings up a logistical dilemma: have fewer veterans been taking advantage of mental health services simply because those services have not been offered clearly enough, or offered at the wrong time (i.e., too close to homecoming, when troops want to just back together with their families.)  We've seen from Vietnam that veterans often don't realize they are suffering from PTSD until many, many years later.  Ideally that cycle time will be cut down considerably with current veterans, because there's much more public discussion about the topic.  However, there still may be improvements that need to be made regarding how and when services are offered to veterans, and possibly offering these services at several intervals is best, with clear communication about their potential usefulness, and peer support from other veterans who have successfully undergone the same types of treatment.

Commander Beverly Dexter, Military Psychologist

Commander Beverly Dexter, Ph.D., is an Active Duty U.S. Navy Psychologist who has served three tours with Marines in the U.S. and Iraq.  She is a warfare qualified former Navy Special Operations Officer (salvage diver and ship driver) and former Navy Supply Corps Officer.  She completed operational tours on four Navy ships and frequently gives professional military presentations on leadership, resilience building for military families and prevention and treatment of trauma.  CDR Dexter has lived military life as a single person, double active duty couple, "dependent" wife and mom, deployed mom, stationed overseas and deployed to a combat zone.  She is the Founder and Chairman of the EMDR International Association Military Special Interest Group and the ISTSS Military Special Interest Group.  Dr Dexter is a leader in the effort to improve trauma treatment for Active Duty, Reservists, and National Guard returning from combat and for their families, and has considerable experience serving Army National Guard troops in Iraq.  Dr Dexter is EMDRIA Certified in EMDR and a Fellow and on the Speaker’s Bureau of the American Academy of Experts in Traumatic Stress.  Author of the forthcoming book, No More Nightmares:  How to Use Planned Dream Intervention to End Nightmares (scheduled for release in 2008), she has taught her original theory of Planned Dream Intervention to thousands of individuals who have experienced rapid resolution of recurring dreams and nightmares.

Words of Wisdom for Veterans from Down Under

The Vietnam Veterans Association of Australia -- whose excellent motto, "Honour Those Who Died, But Fight Like Hell for the Living," we strongly agree with -- is a good source of information on the Australian government studies on the health of Vietnam veterans and their families.  These are important studies for any number of reasons, but for our purposes, because they make the point that combat trauma affects not just the veteran but also his or her family, and transfers effects into the next generation.  Their extensive information about the original Australian study, first published in 1998, is linked here.  They comment: "The responses themselves tend to support the hypothesis that the health status of the veteran has an effect on the health status of his immediate family."

Here are some specifics: "36% of veterans report that service in Vietnam, or health problems arising as a consequence of their service in Vietnam, have had a serious adverse effect on current or past partners.  Some 40% report physical or psychological health problems in their partners that they feel may be related to the veterans' Vietnam service.  Stress (40%), anxiety (34%), and depression in partners are the most commonly cited conditions.  Thirty nine percent (39%) of all veterans with partners report that treatment has been required for these conditions.  Those with greater length of service in Vietnam report higher levels of problems."

Though they noted that "the report notes difficulties that may have affected the accuracy of reporting and the accuracy of the comparison data" regarding the children of veterans, they found that settling those difficulties and verifying the results was an urgent matter, because the study concluded that, besides physical consequences to veterans' children (e.g., birth defects, etc.), that "deaths from suicide of children were reported at three times the expected rate, and deaths from accident or other causes were reported at twice the expected rate."

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The Australian Broadcasting Corporation did a news segment on "The 7:30 Report" on June 1, 2006, about these studies, called "Veterans Fear War's Impact on New Generations."  The main reporter was Natasha Johnson, and a key interviewee was Melbourne University professor Hedley Peach, an Australian public health researcher, and adviser to their government's Department of Veterans Affairs, who had spent two years evaluating the study.  Professor Peach remarked, "there's absolutely no doubt that the effects of war [are] not going to be confined just to the person who went to war."  The Australian study showed "significant mental illness among veterans also showed their children had a high rate of accidental death and a suicide rate three times that of their peers in the general community."  The problem with studies, Peach pointed out, is if they serve to simply describe the problem accurately.  It's the government who should "develop strategies in the meantime to promote resilience and break the cycle of mental illness."  The interesting transcript of that short program is linked here.  One result of the studies is that the Australian government has made counseling services available to all veterans and their families. The U.S. House Veteran Affairs subcommittee on health is contemplating expanding veterans' mental health care to families as well.  Read more about the Australian counseling decision in the PDF linked here.

Mental Health of Veterans' Family Members Deserves Attention, Too

Just a quick note to mention that Todd Bowers, Director of Government Affairs at the highly pro-active Iraq and Afghanistan Veterans of America ("IAVA") recently testified before the House Veterans' Affairs Subcommittee of Health about an additionally important topic: the mental health of veterans' family members.  The topic?  "Mental Health Treatment for Families: Supporting Those Who Support Our Veterans" -- that would make a great slogan.  (A few days later, the Christian Science Monitor also covered this topic, in an article entitled, "A New Push to Help Families of Veterans."  That article is linked here.)

It's no secret though perhaps it should get much more attention that combat trauma affects not only veterans but also those in their immediate families.  A veteran's suffering affects his or her family members significantly, as the burden of caregiving falls most strongly on the veteran's immediate family.  There are physical, emotional, social and financial costs to caregiving, not the least of which is strained mental health.  At least with Vietnam veterans, studies have shown that children of veterans with PTSD are at increased risk for suicide themselves. (Although it's the subject of some controversy, an Australian government study of their own Vietnam veterans concluded that children of veterans were three times as likely as the general population to commit suicide.)  It's great to see that the IAVA is making the case that more resources need to be allocated for families' mental health resources as well.  For more information on this important topic, see the IAVA blog entry linked here, or the House subcomittee's site, linked here.  For a link to the audio coverage of the hearings, click here.  For earlier blog posts on caring for the caregivers, click here; or about the family, click here.

Editor's Note: It's interesting to note that just today, the Australian government published its conclusion, that counseling services would be made available to their veterans and families.  To read more about it, download this PDF.  To learn more about the Australian Vietnam veterans health studies, click this link to a subsequent blog post.

Upcoming PTSD Conference on Healing and Hope

The Washington State Psychological Association will be having its annual conference April 11th and 12th at Shilshole Bay Marina, in Seattle, Washington.  The title of the conference is "Healing and Hope," and it will largely focus on issues of concern to veterans and their families.  Topics at the conference include, on Friday, April 11th: "Focus on Military Families, Issues and Treatment," presented by Beverly Dexter, Ph.D., and "Treatment of Trauma, Combat Stress and PTSD," also presented by Beverly Dexter, Ph.D.  On Saturday, April 12th, the topics include: "Nightmares No More: Treatment of Trauma-Related Nightmares," by Beverly Dexter, Ph.D.; and a final session/panel discussion entitled, "Self-Care for the Warrior Moments in Our Lives: A Lifestyle Consideration."  This panel discussion will include E.B. Vance, Ph.D., Bill Proctor, Ph.D., Mark Soelling, Ph.D., and Kathy Wilmering, MSW, ARNP.  Who should attend: psychologists, professional clinical counselors, MFTs, social workers, psychiatrists, and other mental health professionals.  To learn more about the conference, or to register, click here.  To learn more about Beverly Dexter, Ph.D., click here. 

(Dr. Dexter will be a pre=conference speaker on the topic of PTSD and the military at the EMDR International Association conference in September in Phoenix, AZ later this year.  Information on that upcoming conference is linked here.)

Survivor Guilt: Making Peace with the Past

Mark Goulston, M.D.'s aptly-titled, Post-Traumatic Stress Disorder for Dummies, which came out late last year is, I read somewhere, the book he says he wished he'd been able to read, when he graduated from medical school.  Be that as it may, the book has some useful insights.  Page 151 of the paperback edition talks briefly about "survivor guilt."  Goulston calls this "a feeling that happens when you feel guilty that you lived through a trauma while another person* died."  He says, "Your therapist can help you get past this misguided guilt in many ways.  One is by seeing that your survival is an achievement, not a reason for shame.  Another is by helping you find ways to honor the person who died in the trauma."  As far as making the shift to view your survival as an achievement, not a shame, read our most immediately recent post, which is on the subject, linked here.  As far as finding ways to honor the person who died, that's part of what veterans are doing when they journey together to memorials like the Vietnam Wall, or even, as many have done, back to Vietnam itself.  Iraq and Afghanistan veterans are going to need their own touchstones, like the Vietnam Wall, which will help them to heal as well.

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*I would hesitate to add, there's often an added value judgment on the part of the survivor that the person who died was a better, more worthy person, who would have done more, had they lived; or did more, while they lived, than the less-deserving person (usually the self, speaking) who survived.  This only adds to the guilt, even if it's a wrong or at least misguided perception to begin with.

When "Luck" Doesn't Seem So "Lucky" After All: Coping with Survivors' Guilt

Survivors' guilt, at its most basic, is about coming to terms with the very arbitrary nature of luck/fortune/chance.  Some tragedies in life pass by us; others touch us directly.  Woody Allen had an old joke, when someone asked him if he'd like to achieve immortality through his work.  No, he said, "I'd like to achieve immortality through not dying..."  Cynics might claim that those who die have it easy -- at least they're not left to deal with the wreckage.  For those left behind, when a tragedy occurs, the grieving can seem harder than the going.  And the incessant questioning, "why ME?!"  Sometimes luck doesn't feel so lucky, when it's someone you deeply cared about who died, and you're left behind to carry on.  Go ahead and excuse the surface-y nature of this post, please.  There's obviously a lot more to survivors' guilt and how it makes people feel, as well as how to overcome, than this little cheese-whiz post is going to convey.  It's not meant to be a quick fix.  However, in the spirit that sometimes it's worthwhile to challenge your unconscious thoughts about a situation that plagues you, here are some items I ran across a few years ago on the Web.  Attribution unknown, sorry to say. 

Survivor’s Guilt - Opportunities to Challenge Your Thinking

• Thank goodness -- you survived!
• More people than you know are happy that you survived.
• Over the course of a lifetime, we are saddened by so many deaths
• Even if the rest of your life seems insignificant to you, we are relieved that you are alive
• Know that there is no shame in surviving
• It is good to survive
• It is okay to delight in being alive
• Feel free to reassess your life
• Reassess what is valuable to you
• Make the best of your life
• Making the best of your life can be a tribute to your survival and to those who died
• Take the opportunity to re-evaluate the meaning of your life
• Is your life all it can be?  If not, why not?
• What is or can be your purpose? your talent? your benefit to life?
• Bloom where you’re planted
• Process the traumatic experience and its associated symptoms with the appropriate assistance
• Put guilt to good use
• If it is in your nature to do so, cherish life
• Treasure being alive
• Whether you survived due to fate, a purpose, luck, chance, or you just did," it's a truth that long life and kindness are not guaranteed to any of us
• Each day and each act of kindness can be treasured as gifts
• Treasure the best of each day
• Be aware of your physical mortality in good and positive ways
• Understand that appreciating or cherishing life may be easier after recovery from trauma
• Recognize the reawakening of old issues
• Survival may have triggered old feelings of worthlessness or unworthiness
• Surviving may have amplified old messages that you received about not being worthy, about being a nuisance, about not measuring up, and/or about not counting
• If guilt persists or disrupts life, seek appropriate therapeutic assistance

Editor's Note: One instructive book about the general topic of how to process grief is, Living with Grief after Sudden Loss: Suicide, Homicide, Accident, Heart Attack, Stroke," edited by Kenneth J. Doka, Ph.D.  Although the subtitle there shows you there's not just one type of death discussed, it fails to mention that there's also a chapter in the book called "Complicated Grief in the Military."  The book was published in 1996, so it doesn't take this war into account, but the principles are general and reasonable.  In the conclusion to the book, Kenneth Doka, Ph.D. lists five critical points about surviving grief.  They are: "that grief is a highly individual[ized] reaction; that different types of sudden loss create unique issues for survivors; that survivors are often coping simultaneously with both grief and loss of their normal world; that survivors of sudden loss need both short-term and long-term intervention; and that caregivers at all levels may be affected by traumatic loss, so self-care is critical."  He notes, finally, that "communities need to be proactive."  That's what we're attempting to do, here.

Alcohol No Cure for Painful Memories, Study Finds

Many people, including combat veterans, say they turn to drink to "drown their sorrows," or attempt to "wash all their troubles away," however momentarily.  The idea of turning to alcohol consumption, even alcohol abuse, to deal with stress and trauma is a common one in today's society, not just among injured combat veterans and other trauma survivors.  People typically believe that alcohol numbs painful experiences, and veterans often turn to alcohol to deal with sleep disturbances and insomnia. 

Now there's scientific evidence that says alcohol may actually be having the opposite effect.  A recent study in the medical journal, Neuropsychopharmacology, says that, in layman's terms, drinking actually increases sorrow, not minimizes it.  The study, which was done with rats, indicates that the ethanol in alcohol is apparently able to block painful memories from being acquired,; but for painful memories we've already acquired, it has the opposite effect - it locks them into our minds, or reactivates them.  Yikes.  Yet another reason to not look for a best friend, or a therapist, at the bottom of a glass.

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Additionally, as the U.S. Department of Health and Human Services - Substance Abuse and Mental Health Services Administration points out, alcohol addiction prevents larger healing from taking place.  They state, "Many victims turn to alcohol or other substances in an attempt to get some relief from their emotional turmoil and suffering. All trauma survivors manage their experiences in different ways. However, substance abuse is not only ineffective in healing from trauma, but it also can present a host of additional problems that make the healing process even more difficult."