Healing Combat Trauma

More Combat = More Trauma, and More Chance of Developing PTSD, Study Shows

For anyone who's every wondered about whether troops' increased exposure to combat trauma results in greater chances of their developing PTSD, the answer is a definite "yes," according to a study released in the February issue of the Psychiatric Times, linked here.  The article from which excellent graphic (left) is taken is entitled, "Posttraumatic Stress Disorder in Veterans," and it makes the point that cumulative exposure to combat trauma predicts PTSD in a linear fashion.  Less exposure (fewer firefights) -- lower rates of PTSD; higher exposure (greater number of firefights) -- higher rates of PTSD.  According to the article, it really is that simple.

The article's authors cite an earlier published report of OIF (Iraq) and OEF (Afghanistan) servicemembers, and found high rates of exposure to both "traumatic situations and combat."  "According to the study, about 33% of soldiers in Afghanistan and 71% to 86% of soldiers in Iraq experienced a firefight. PTSD rates ranged from 6.2% for veterans of Afghanistan's OEF to more than 12% for OIF veterans. The risk of PTSD was found to increase linearly with the number of firefights (see graphic, above). Having been wounded, a condition previously found to be predictive of PTSD, was also significantly associated with PTSD. As is commonly found in patients with PTSD, rates of depression and alcohol use also increased following combat exposure."

When we think of tragic stories of what we can only assume to be PTSD-fueled incidents in the news -- the recent suicide of Marine SSgt. Travis Twiggs, the arrest of Marine LCpl. Eric Acevedo for murder, and others like them -- we should really stop to pause and wonder, how many times have these servicemembers been deployed, for how long have they been in combat, and to what have they been exposed (meaning, how many firefights)?  Twiggs, it turns out, had done four(!) tours of Iraq, and one of Afghanistan (earlier reports mentioned four total, but they were wrong); Acevedo had done three tours of Iraq by the time he was 22, including one that involved a horrific battle, where 10 members of his battalion died on a single day, and several others were wounded.  To not take the effects of their cumulative exposure -- what they saw, did, were witness to -- is just unconscionable.  We have a very love-hate relationship with the glory of serving in this country: we glorify our military heroes for their astounding feats of endurance (Brad Kasal, the Marlboro Marine, etc.), but we also equally unreasonably vilify them when they crack under the all-too-obvious strain.  It seems like what we need most of all is just the sober estimation: the more servicemembers have gone through -- and suffered -- the more we can expect them to have problems later on, with developing PTSD.  As noted Australian Vietnam War researcher Hedley Peach said in a slightly different context, what we're really looking at here is not something unusual -- it's the generic effect of combat.

Where Is Suicide Most Prevalent Among Young Males in the U.S.?

Forgive me for being naive, but I had no idea "suicidology" was such a sophisticated profession.  Such specificity!  Such granularity!  Such nice maps, even. (Thanks, Centers for Disease Control!)  Finding out who kills themselves nationally by type -- race, age, gender -- is seemingly pretty doable -- and if you know where to look, the maps already exist.  There's something called "the Atlas of United States Mortality," and it's a veritable treasure-trove online of useful and useable data. Here, for instance, is a map of where 20 year old white males, are most likely to kill themselves in the U.S. -- followed by a similar map for 20 year old black males.  Notice that, apart from some places in the Southwest, there's actually not much overlap between the two maps.)

Want that same data for 20 year old white women or 20 year old black women?  It exists, too. Not sure if anyone's done the Hispanic data yet, but if not, they should.  (All the above data is from the PDF, linked here.)  Want to find the same data about how many people use a firearm to commit suicide, mapped against a map of the United States?  Here it is.  Want to find the same information about those who die by motor vehicle accidents (among whom is a certain percentage of undisclosed suicides)?  It's here.

In an Op-Ed piece from the Boston Globe from August of 2004, Michael Craig Miller, M.D., editor-in-chief of the Harvard Mental Health Letter, talks about what he learned from doing his own suicide map of the United States.  (Ironically, he found that it coordinated roughly with political lines, but that wasn't his only observation, so we'll set that one aside for now, lest it inflame but not inform.)  He was surprised to see a roughly three-fold difference between high and low states, even after accounting for age and ethnicity.  Searching for the factors that might contribute to this, he speculated:

"Local and individual factors are important: personal loss, family conflict, economic travail and unemployment, the quality of the support system, and cultural or religious beliefs about death or suicide. Easy access to guns is risky for a vulnerable person.  Access to mental health services, on the other hand, reduces the risk of suicide, which is usually a result of mental illness. But stigma is an enormous obstacle to treatment. Most people with mental disorders fear a negative or patronizing response, even from health-care providers. The more severe their distress, the greater the dread of reaching out."

I'm interested in this whole topic because I'm trying to figure out how to plot the average age of military members in various states, and their ethnicity -- against their likelihood of committing suicide, even before combat -- to see if we can ascertain whether mental health services are adequate for returning and deployed military in those states.  This is pretty much a work in progress, and not the quickest thing I've ever done -- so bear with me over the next few days, as we find this out -- together.

One positive remark by Dr. Miller, concerning military efforts: "The US Air Force has recently achieved remarkable success in preventing suicide. In 1996, the leadership instituted a service-wide program to increase awareness of suicide risk factors and make resources available for treatment. High-ranking officers championed the cause, which helped reduce the stigma attached to seeking help for problems like depression. The result was a 33 percent reduction in the rate of suicide among Air Force personnel."

If this is true/has remained true, I'm curious to know whether the Air Force's program served as a model for the other services.  From the absence of any talk confirming that in the media, it would seem that it either hadn't or didn't -- either that, or no one saw fit to mention it.  (They have one of the lower profiles of the services in the OIF/OEF efforts.) Another possibility is that there just isn't that much coordination among the armed services on mental health issues, so each service is developing a program on its own -- the time-consuming, re-inventing the wheel kind of way.  I really can't speak to that, because I don't know anything about it -- but over the coming days, maybe we'll find that out as well.

Editor's Note: Dr. Miller's Op-Ed piece from the Boston Globe is linked here.

Montana's National Guard Holds Public Meetings on PTSD

Recently we wondered what National Guards in the various states with high suicide rates for males were doing, or not doing, about mental health screening for returning or deployed troops.  We found some (slightly) positive news: that the National Guard in Montana, which as a state has the highest rate of suicide for males per capita in the nation -- something we blogged about here -- perhaps in part because of their low population density, but nevertheless -- was doing something about it.  Throughout the month of May, they held hour-long meetings in the community to talk about PTSD, and show a half-hour video they'd made about its signs and symptoms.  The only problem is, of course, that the meetings were only an hour long -- and with a half-hour video as part of that, probably left slim time or attention for questions and answers and feedback.  Still and all, some time is better than no time devoted to this important issue, so we commend the Montana National Guard for trying.

The hour-long meetings were held the week of May 19th. Four separate teams of soldiers and airmen will be conducting the meetings, according to Col. Jeff Ireland, the director of personnel and manpower for the Montana National Guard. “We want to take this information to the people of Montana so that they understand what PTSD is and what they can do to help their friends, neighbors or relatives that may be affected by PTSD,” he explained.

“The Montana National Guard is dedicated to ensuring that all Montana’s Soldiers and Airmen are taken care of before, during and after a deployment in support of our state and nation. Our efforts are to reach out to the people of this state and get their help,” Ireland said.

The meetings schedule will include the viewing of a 30-minute video produced by the Montana National Guard about PTSD and its impact on service members and their families. In addition, a question and answer period will be held to get ideas and feedback from attendees.

The public was encouraged and invited to attend the meetings. For more information, contact Capt. Jeremy Hedges at (406) 324-3986 or visit the “Beyond the Yellow Ribbon” campaign on the Montana National Guard's website, linked here.

Does Suicide Data for Combat Veterans Match or Contradict Suicide Data by State?

Who knew there was such a thing as a "Suicide Map of the United States," but it stands to reason that such a thing exists, because the data it illustrates can be mapped.  (The map at left is rather old, but serves to illustrate the point.)

Each year, the United States, through the Centers for Disease Control (CDC) in Atlanta, collects data by state of how many people have killed themselves, and from this data can form a ranking of suicide rates by state and gender.  My question is -- do suicide rates among veterans follow the pattern previously set by state?  And perhaps more importantly, are the military installations in a given state (like the National Guard) aware of how prevalent suicide among young males is or isn't in their state, so they can react accordingly, and perhaps increase screening of veterans for suicide risk?

From 2005 data, collected by the CDC, the top states for suicide by males are ranked in the following order: 1) Montana; 2) Nevada; 3) Alaska; 4) New Mexico; 5) Colorado; 6) (tied for 5th place) - North Dakota; 7) South Dakota; 8) Idaho; 9) Wyoming; 10) Arizona; 11) Oregon; 12) Tennessee; 13) West Virginia; 14) Oklahoma; 15) (tied for 14th place) - Arkansas; 16) Utah; 17) Maine; 18) Kentucky; 19) Kansas; 20) Mississippi; 21) Washington state; 22) Missouri; 23) New Hampshire; 24) Florida; 25) Indiana; 26) Alabama; 27) Ohio; 28) Vermont; 29) South Carolina; 30) Pennsylvania; 31) Wisconsin; 32) Virginia; 33) Louisiana; 34) North Carolina; 35) Michigan; 36) Iowa; 37) (tied for 36th place) - Minnesota; 38) Delaware; 39) (tied for 38th place) - Texas; 40) Nebraska; 41) Georgia; 42) Maryland; 43) Illinois; 44) California; 45) Connecticut; 46) Hawaii; 47) (tied for 46th place) - Massachusetts; 48) New York; 49) New Jersey; 50) Rhode Island; and 51) District of Columbia.

The Minnesota National Guard has stood out for its proactive stance on reintegration services for returning combat veterans - we've blogged about their efforts earlier, here.  But according to the data above, Minnesotans males are 37th least likely in the U.S. to commit suicide. The New Hampshire National Guard has a program that's apparently a model for the nation -- we blogged about it earlier, here -- but New Hampshire males are 23rd least likely in the nation to commit suicide.  The Vermont National Guard has also taken proactive steps to help its veterans reintegrate successfully -- we blogged about that, here -- but males in its state are 28th least likely in the U.S. to kill themselves. 

How about the Montana National Guard, the Nevada National Guard, the Alaska National Guard, the New Mexico National Guard, the Colorado National Guard, the North Dakota National Guard, and so forth -- are they taking steps to educate their servicemembers at risk for suicide?  Ironically, as we blogged about it, here, in March of 2006, the Iowa National Guard -- and Iowan males are 8th in the nation, according to the above data, in suicide risk -- had  downgarded their mental health counseling for returning veterans from "mandatory" to "optional."  Let's hope they've since changed that and made effective screening mandatory -- along with all 50 other states.  Of the National Guards in the top six states at risk for male suicide mentioned above, only one -- Montana -- has any mention of mental health issues on its website.  The Montana National Guard seems to have been holding a series of public meetings in May for Montanas to help recognize PTSD in their returning servicemembers.  See that link, here.  A great step forward, at least for the Montana National Guard, in the state that has the highest suicide rate for men in the nation.

Data source: CDC's WISQARS website "Fatal Injury Reports," http://www.cdc.gov/ncipc/wisqars/; downloaded January 24, 2008.  Prepared by John L. McIntosh, Ph.D., Indiana University, South Bend, for posting by the American Association of Suicidology -- January, 2008.  (The American Association of Suicidology's website is linked here.)

The Killer Headache: Migraines, PTSD and Increased Risk of Suicide among Veterans, Teens

Remarkable scientific data first reported over a year ago -- which seems to have created nary a flicker of interest in the media, though it absolutely should have -- links veterans' experience of migraine headaches with likelihood of experiencing PTSD, depression and anxiety.  Similar research in teens -- and many combat veterans, after all, are barely out of their teens -- indicates that those who suffer migraine headaches most frequently are also at greatest risk for suicide.

In soldiers:

Soldiers returning from combat in Iraq who have migraine headaches are more than twice as likely to also have symptoms of post-traumatic stress, depression or anxiety than soldiers who do not have migraines, The study involved 3,621 United States Army soldiers who were given a health screening questionnaire within 90 days after returning from one year of combat duty in Iraq. A total of 2,167 of the soldiers, or 60 percent, completed the questionnaire. Of those, 19 percent screened positive for migraine headaches, 32 percent screened positive for depression, 22 percent screened positive for post-traumatic stress disorder, and 13 percent screened positive for anxiety.

The researchers found that 50 percent of those with migraine also had depression, compared to 27 percent of those without migraine. A total of 39 percent of those with migraine also had post-traumatic stress disorder, compared to 18 percent of those without migraine. And 22 percent of those with migraine also had anxiety, compared to 10 percent of those without migraine.

"Previous studies in non-military populations had revealed a higher prevalence of certain psychiatric conditions, such as depression and anxiety, among people with migraine," said study author Maj. Jay C. Erickson, MD, PhD, of Madigan Army Medical Center in Tacoma, WA. "We hypothesized that there would be a similar relationship between migraine and psychiatric conditions in soldiers. The precise reasons for such an association are not fully understood, but may be related to similarities in the mechanisms underlying migraines and some psychiatric disorders."

The study also found that those with migraine and depression also had more frequent headaches than those who had migraine with no depression -- an average of 3.5 headache days per month for those with depression compared to 2.5 days per month for those with no depression. The findings were similar for those with migraine and post-traumatic stress disorder.

"These findings should alert health care providers, especially those affiliated with the military or veteran health care systems, about the frequent association of migraine headaches and psychiatric conditions in soldiers returning from deployment," Erickson said. "We recommend that health care providers who evaluate combat veterans for headaches perform mental health screening in order to ensure that psychiatric disorders are identified and properly treated. All soldiers returning from deployment presently undergo mental health screening."

This research was presented at the American Academy of Neurology's 59th Annual Meeting in Boston, April 28 -- May 5, 2007. Full citation: American Academy of Neurology (2007, May 4). For Iraq Veterans, Migraines May Be Sign Of Other Problems. ScienceDaily. Retrieved May 30, 2008, from http://www.sciencedaily.com­ /releases/2007/05/070503075228.htm

For teens:

Teens who have chronic daily headache, especially those with migraine headaches, are at greater risk for suicide than teens who don't have migraines, according to a study published in the May 1, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology. Teens with migraine are also more likely to have other psychiatric disorders such as depression and panic disorder.

Reported in ScienceDaily, May 1, 2007.  Full citation: American Academy of Neurology (2007, May 1). Teens With Migraine At Greater Risk Of Suicide. ScienceDaily. Retrieved May 30, 2008, from http://www.sciencedaily.com­ /releases/2007/04/070430181213.htm

Honor the Dead, but Fight Like Hell for the Living

A suitable slogan to commemorate this past Memorial Day, and not far different from the motto of the Australian Vietnam Veterans Association, "Honor the Dead, But Fight Like Hell for the Living."  If we're ever going to make signficant progress on treating PTSD as a combat injury, that's what we're going to have to do.  And not just for the living, either -- for the ones who died from what they couldn't endure any longer, as well.

Professor Hedley G. Peach (Australia)

BSc(Hons) (Wales), MBBCh (Wales) PhD(London), FFPH(UK)
University of Melbourne

(Retired) Professor, School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland, AUSTRALIA.

Professor Hedley Peach is a Visiting Consultant at the Ballarat Base Hospital, and Professional Fellow at the University of Melbourne.

Professor Hedley Peach qualified as a doctor in Wales where he became interested in the social causes of illness. This interest led him to train in community medicine at the renowned St. Thomas's Hospital in London where he worked for seven years as a lecturer/senior lecturer. In 1985 he migrated to Australia where he was Foundation Professor of Tropical Health at James Cook University for three years and, subsequently, Professor of Community Medicine at Melbourne University for fourteen years. He retired earlier this year but continues as an honorary Professorial Fellow of Melbourne University. He has been interested in the nexus between religion, spirituality and health for a number of years. In 2002, he wrote the first article on this topic to appear in the Medical Journal of Australia to stimulate debate on how the medical profession should respond to research and recommendations from the USA. He has authored book chapters and papers on spirituality and women's health, the religions of rural Australians, and other topics. He has given many radio and newspaper interviews on spirituality and health. He is the author of several books, including The Epidemiology of Common Diseases and Disablement in the Community, as well as the leading author of more than 100 articles in scientific journals. He is a member of the National Heart Foundation's expert group on psychosocial causes of heart disease.

Soothing Sounds: Dean Evenson and Dudley Evenson Make Music for Troubled Troops

Pacific Northwest musicians, Dean and Dudley Evenson, have found a way they can “support the troops” with their music and DVD offerings.  Their latest release, the Eagle River DVD has found its way to Walter Reed. This beautiful 62-minute DVD with widescreen and 5.1 surround sound features soothing music and visuals of eagles and other wildlife along the wild river in the Pacific Northwest which Dean has been videotaping for the past 15 years.  Also included in the package are Guided Relaxation Bonus Features and a printed Relaxation Training Guide designed specifically to help PTSD and trauma victims.

 

Realizing that many people coming back from combat zones are dealing with extreme physical and emotional wounds, the Evensons wanted to put their music and media to work to help ease the suffering.  For more than 25 years, they have been producing music for health and stress reduction through their independent record label, Soundings of the Planet.  Their music has been so popular with healthcare practitioners that the Evensons realized it could possibly be of benefit to soldiers returning from combat.  When they first contacted Walter Reed several years ago, they found that the head chaplain there, Major John Kallerson, had used Dean Evenson’s music in his own healing process so he was quite familiar with its benefits.  Now he hands out Dean’s music and DVDs to his patients, often amputees suffering the results of IEDs in Baghdad.

 

Chaplain Kallerson told the Evensons “The music helps our patients focus on their healing and not the chronic pain they endure constantly. The soothing music of Healing Sanctuary and Healing Dreams provides a needed respite from the dreams and flashbacks of the terrors that our wounded have seen and experienced.  It is helpful for them to relax and not dwell on the bad dreams or images that they can see… Some find them very helpful to get to sleep.” (Editor's Note: The Evensons have also produced the highly-rated Tao of Healing.)

 

Inspired by this feedback, the Evensons began to research the effects of war and the stress disorders that often plague veterans of violent conflict and learned that soothing music and visuals can offer an antidote to some of the emotional traumas experienced.  They put together a Relaxation Training Guide to help returning soldiers in their healing process.  In this guide, they present concepts and techniques incorporating the music, breath, muscle relaxation, visualization, meditation and mantra that can help anyone dealing with trauma and stress.

 

Last year at Walter Reed, Dean and Dudley Evenson performed for wounded soldiers, their families, and hospital staff. The event was televised throughout the hospital so the staff of 5000 as well as the patients in their rooms could view it.  Behind them played the Eagle River DVD and the response from patients and hospital staff was very gratifying.  They commented that the music and DVD were extremely beneficial in helping soldiers suffering from PTSD and other wounds of combat.  The beautiful natural images of the  Eagle River DVD were also helpful in overcoming the nightmares and images of war that plagued so many of them.

 

Video clips of the Eagle River DVD are available at the Evensons' website, linked here.  Click the special section for Service Personnel which offers information to veterans about using music for health and relaxation.  Soundings of the Planet has initiated a PARTNERS IN HEALING program to receive donations so they can distribute music and DVDs to VA hospitals and individuals who cannot afford to purchase them, To learn more about the Evensons’ music, DVDs, and work at Walter Reed, check out their website, linked here.

Army's PTSD Cases Double Over Last Year; Marines Close Behind

An article in yesterday's Washington Post, linked here, reports that diagnosed cases of PTSD in the U.S. Army have more or less doubled over last year, with the Marine Corps also increasing numbers significantly.  The Navy and the Air Force are reporting fewer cases; which either means that they're not seeing as much action or they're lagging in understanding how to report cases; or a combination of both.  It's no surprise to anyone who's been following veterans affairs that the Army, the Marine Corps, and the National Guard have been stretched to the maximum with overlong deployments, back-to-back deployments, and less than fully-adequate attention to the psychological wellbeing on the troops. Let's hope these and future statistics mean something to decision-makers who can make a difference to veterans who have given so much already.

The Army Says It's Aware of Its Rise in PTSD, Suicides

According to a conference call today with the Army's Col. Elspeth Cameron Ritchie, M.D., among others, the Army is allegedly aware of its rise in PTSD and suicides, and making some plans to address the needs for greater access to psychological help, at least according to one blogger involved in the call, John M. Grosol, Psy.D..  It sounds like the Army has roughly half the per capita psychology help available as the civilian world. Let's hope there are plans to increase that as soon as humanly possible.  Lives and wellbeing are both at stake.

Elspeth Cameron Ritchie, M.D.

Elspeth Cameron Ritchie, a colonel in the United States Army, holds a master's degree in public health and a medical degree. She trained at Harvard University, George Washington University, Walter Reed Army Medical Center, and the Uniformed Services University of the Health Sciences, where she is an associate professor of psychiatry. Her assignments and other missions have taken her to Iraq, Israel, Korea, Somalia, and Vietnam. She brings a unique public health approach to the management of disaster and combat mental health issues and is internationally renowned as an expert on the subject. She also has published numerous articles on forensic, disaster, and military operational psychiatry. She is the recipient of the William Porter and Bruno Lima awards. Ritchie is currently the psychiatry consultant to the US Army Surgeon General. She is also the author of "Interventions Following Mass Violence and Disasters: Strategies for Mental Health Practice."

WA Legislator Shows Concern for Vets, PTSD

Washington state, which counts a large number of deployed servicemembers, veterans, and their families among the state's population, has shown some real leadership in veterans' issues, particularly with Senator Patty Murray (D-WA) -- a tireless and vocal veterans' advocate, who is a member of the Senate's committee on veterans affairs.  Now representative Jim McDermott (D-WA), apparently the only psychiatrist serving in Congress (hmmm, that would explain a lot!), according to a news article in yesterday's Seattle Post-Intelligencer, has also done something good for veterans.  He sponsored a veterans' forum to "honor, help and heal our soldiers," according to the PI, and basically provided an opportunity for local, Washington state veterans to vent about their difficulties with getting appropriate care.  Not sure if anything more constructive than venting was really the purpose of the meeting, but hey, even that sometimes really helps -- for people like veterans who may not feel that anyone is really listening to how difficult a struggle they're in, coming back from deployment and being faced with a number of serious obstacles to getting the help they need.  The article is linked here.

War: Is It Glory, or Hell? A Quote from Someone Who Knew

Just ran across this quote allegedly from Civil War general, William Tecumseh Sherman, famous/infamous, among other things, for his "scorched earth" tactics against the Confederate states.  He is supposed to have said, surveying the troops arrayed before him, "There is many a boy here today who looks on war as all glory, but, boys, it is all hell."  Sounds like someone who knew what he was talking about.

More Camp Pendleton Marines Died Non-Combat Deaths Than Died in Iraq Last Week, Marines Admit

Here's a troubling story, where the above headline basically says it all.  An article by Rick Rogers from last Friday's issue of the San Diego Union-Tribune, entitled "Marines hit by rash of non-combat fatalities," and linked here -- has this stunning factoid tucked away, several paragraphs into the story:

At least 13 Marines from the 1st MEF – most of them stationed at Camp Pendleton – have died this year. Most of the causes are believed to have been vehicle crashes, homicides and suicides, although some cases are still being investigated.

By comparison, six Camp Pendleton-based Marines have died from combat in Iraq during the same time period, according to the Defense Department.

The reporter also notes, "None of the Marine officials interviewed for this story could remember a worse week in terms of noncombat losses."  So sad.

It's important to note that sometimes reckless driving is "just" that, and sometimes it's a form of vehicular suicide, whether fueled by alcohol and/or drugs, including prescription medications, whether mixed with alcohol or not.  (Much like "suicide by cop" has become something other than a random altercation with police.)  The Marines, faced with an increase in motorcycle fatalities, are taking pains to educate the troops more about the risks involved -- risks which are probably fairly well understood, though not necessarily attended to.  Heartbreaking news from Southern California, in any case -- for all the Marines, and their families, not to mention those who've served with them.

Making Art from War: Art Therapy as a Treatment for Combat Veterans

A recent article entitled, " Art Therapy for Combat-Related PTSD: Recommendations for Research and Practice," make the heavily-referenced case that we shouldn't overlook art therapy's potential for treating PTSD in combat veterans -- particularly because of its nonverbal nature, and its ability to integrate and express experience trapped below the level of conscious thought.  Typically, art therapy has been under-studied, or studied with victims of trauma who are children, not combat veterans -- but over time, those facts are changing.  The article, linked here, and referenced in a previous blog post linked here, is well worth reading.

They introduce their argument by saying (citations are everywhere in the original article, I'm leaving them out of this summary) that PTSD is difficult to treat in part because no single treatment has emerged as the clear leader, with effectiveness across the board.  Similarly, PTSD can be somewhat intractable to treat because any trauma severe enough to cause PTSD seems to affect the brain's underlying physiology.  Pharmaceutical drugs and talk therapy, among other treatments, are commonly-used approaches for treating PTSD, but the attractiveness of art therapy as a treatment is expressly because of its non-verbal nature.  It has the potential to allow combat veterans to process and integrate what has happened to them, without specifically requiring them to talk about it -- something many veterans are reluctant to do.

Some interesting points from the article:

 

PTSD is thought to be caused in part by the nature of traumatic memories, which are encoded in implicit as well as declarative memory systems and are likely to exist primarily as dissociated emotional, perceptual, or sensory fragments with no coherent verbal, symbolic, or temporal basis (O’Kearney & Perrott, 2006; Reisberg & Hertel, 2004).

 

Furthermore, implicit and declarative memories of an event can become disconnected due to trauma. These qualities of traumatic memory make it hard to describe traumatic experiences in words or to “integrate” them as part of one’s life story (Christianson, 1992; van der Kolk,Hostetler, Herron, & Fisler, 1994). The failure to process information symbolically (verbally or otherwise) after a trauma is thought to be a core element of PTSD (van der Kolk & Fisler, 1995). Indeed, brain imaging research has demonstrated hypoactivity in Broca’s area, which is involved in the motoric aspects of speech, and hyperactivity in the amygdala (fear, anger), hippocampus (memory), and occipital cortex (visual processing), among veterans with PTSD (Rauch & Shin, 1997).

 

By their nature, traumatic memories are difficult to express in words alone. Non-verbal expression, as is used in art therapy, can facilitate both the shift to declarative memory and the creation of a coherent narrative. The narrative can be pictorial rather than verbal. Indeed, visual imagery may be necessary for the symbolic processing involved in constructing a trauma narrative (van der Kolk & Fisler, 1995).

 

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Additionally,

 

Although art therapy has not been extensively researched, a number of small studies of art therapy for veterans with PTSD have yielded promising results. In a study designed to identify which components of a specialized inpatient PTSD program (SIPU) were most effective, Johnson and colleagues (1997) found that art therapy was the only component among 15 standard SIPU components, such as group therapy, drama therapy, community service, anger management, and journaling, that produced the greatest benefits for veterans with the most severe PTSD symptoms. (The other 14 components were most effective for those with the least severe symptoms.) They also found art therapy to be exceptional in that the veterans could tolerate war-zone content during art therapy and could not do so during other activities. The authors surmise that art therapy was more effective than other therapies because it provided pleasurable distraction in conjunction with exposure to difficult content and thus allowed traumatic material to be processed without the negative short-term side effects of verbal introspective interventions. Other studies also have found art therapy to be more effective than verbal therapy for veterans with PTSD. Morgan and Johnson (1995) assessed a drawing task for treating nightmares in combat-related PTSD and found that those who did the drawing task when they were awakened by nightmares had fewer and less intense nightmares than those who did a writing task.

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Editor's Note: To learn more about art therapy, or to find an art therapy practitioner who may have some experience with PTSD (and there could be very few who do), contact the American Art Therapy Association, Inc., 11160-C1 South Lakes Drive, Suite 813, Reston, VA 20191.  Tel.: (888) 290-0878 or
(703) 212-2238.  Their website is linked here.

 

 

 

 

 

 

Art Therapy for PTSD

Recent research involving children and adolescents with posttraumatic stress disorder (PTSD) indicates that art therapy may be a promising treatment. PTSD is an emotional disorder that may be caused by a one-time traumatic event, such as natural or man-made disaster, or by repeated traumatic experiences such as physical abuse, community violence, or maltreatment. Children and adolescents respond differently to trauma-inducing events than do adults and often display PTSD symptoms through creative expression such as drawing, painting, play, or storytelling.

In the latest issue of Art Therapy: Journal of the American Art Therapy Association,Francie Lyshak-Stelzer, ATR-BC, LCAT, Creative Arts Supervisor at Bronx Children’s Psychiatric Center, NY, and colleagues report the results of a study to determine if trauma-focused art therapy (TF-ART) reduced symptoms of PTSD in adolescents in an inpatient psychiatric facility. When compared to a group of adolescents who participated in a standard arts-and-crafts activity protocol, the youth who received the TFART group sessions had a greater reduction in PTSD symptoms as measured by a widely used trauma reaction index. Lyshak-Stelzer notes that while these results must be replicated in other studies, the current findings look promising. In the same issue of Art Therapy, Ohio art therapist Rebekah Chilcote [see photo] describes her work with child survivors of the 2004 tsunami in Sri Lanka. The small island nation, just off the coast of India, was one of the hardest hit with over 30,000 people killed in the disaster. Chilcote observes, “The children’s artwork revealed traumatic tsunami experiences, the importance of family, loss of loved ones, and religious and cultural heritage.

Tasks, such as ‘the day I will never forget’ helped these children express their feelings about the events.” Chilcote has also provided art therapy to children in Africa and Cleveland, OH. Art therapists have been central to disaster relief efforts worldwide, including work with child survivors of Hurricanes Katrina and Rita. They continue to provide much-needed services to the Gulf Coast region of the US.

For information about art therapy, please visit the AATA website, linked here. The American Art Therapy Association, Inc., was founded in 1969 and develops and promotes educational, professional, and ethical standards for the practice of art therapy. The AATA provides information to its members and the public regarding the field of art therapy through publications, a scholarly journal, and an annual conference.

Travis Twiggs' Widow, Kellee, Puts a Human Face on the Suffering of PTSD

I come away just so impressed with Kellee Twiggs, the grieving, sympathetic widow of the late USMC Staff Sergeant Travis Twiggs, who passed away recently, one might say, from PTSD complications, after a long and difficult battle with that powerful adversary.  Kellee was as much in the dark about the events immediately leading up to Twiggs' suicide as anyone else watching this painful scenario unfold; but she was and is very clear on the ravages PTSD took on her wonderful husband, who she dearly loved.  There's been a great raw video interview footage on the Web for the last few days of Arizona tv reporter, Suzanne Kennedy, interviewing Kellee Twiggs about PTSD and her husband, Travis.  Because it's unclear how long that video will stay on the Web, and also because so much of the Twiggs' story is worth knowing, I took the time to create a transcript of the interview, a downloadable copy of which is available here, Download transcript_of_kellee_twiggs_interview.pdf.

In the interview, Kellee Twiggs, who I very much hope has a future as a patient advocate, given what she's gone through, and how personally she knows the ravages of PTSD in a combat veteran's life, comes across very well -- as a kind, sympathetic, reasonable person, who ultimately feels that the Marine Corps did not do enough to save her husband's life (and that the current courses of treatment for PTSD -- at least the ones Travis was exposed to, with their emphasis on locked wards and overmedication with a slew of pharmaceuticals -- aren't the most effective treatments possible.  From her vantage point, they were tried with her husband, and they just didn't work.  Is her point of view that of a treatment professional?  No.  But it's very much as someone who loved her husband, and cared what he was going through -- and ultimately saw the system fail.  One of the most interesting parts of the video to me was how she isolated the need to address the guilt that her husband felt, and was apparently unable to overcome, from letting others down.  It's a very interesting video interview.  Watch the entire clip, here; or read the transcript, linked above.  And keep the Twiggs family in your thoughts and prayers this Memorial Day and after.  It's hard enough to be a military family with a deployed servicemember.  It's even harder to be a military family grieving a terrible, combat-related loss, as the Twiggs are presently.

The Tragic Last Days of Travis "T-Bo" Twiggs

Well, the national reporting on this story that we broke on Tuesday of last week has finally dribbled in – some of it good, most of it painfully mediocre – and none of it frankly enlightening, if you’ve been following his story here at all. (And btw, CNN hasn't covered it yet, though logically at some point they will have to, if only to keep up with the Joneses.  It's pretty embarrassing to see what they deem worth covering instead, versus treating this American hero's death with any coverage at all.  Here is a slate of what CNN deemed more worthy of coverage just today (the breathless exclamation points are mine, but they seem in keeping with the "Mad magazine meets Entertainment Tonight!" reportage topics -- or is it becoming, "News of the World," with a little political commentary thrown in?)  More worth covering than Travis Triggs, four tours of duty and PTSD sufferer, we have: "Cancer survivor pitches no-hitter!" "Photographer snaps own javelin-spearing!" "Autistic boy, 13, banned from church!" "Wealthy Town Wants Its Own Currency!" and best/worst of all: "Yearbook [staff] switches kids' heads, bodies [in yearbook]!"  (I'm firmly convinced CNN is now staffed entirely by two prepubescent boys, and the story line-up on any given day is an accurate reflection of what they'd find interesting, given that they're 11 years old, and boys, and all.) 

A hard shock in the recent, actual news coverage about Travis Triggs was learning that his wife, Kellee, though she knew her husband was deeply troubled by PTSD, didn’t realize he was in Arizona, and didn’t learn that he killed himself, until she saw it on a news report. That has to just add to the horror of the whole situation.  (At the end of this entry, we'll share some nice things people have been saying in Travis Twiggs' memory, about the man and the Marine.)

One of the things that’s been great is the interviews she’s given to the media, captured in video and audio files, such as we blogged about here – because what we’re getting there is the wife’s perspective on what went wrong with T-Bo, from someone who knows him (pun coming) intimately, and also someone who’s known him for years. (They grew up together in Louisiana.)  (I've linked to the main raw interview footage in this blog entry, here.)

At some point I’d like to make an actual transcript of the interview with the Arizona TV reporter, Suzanne Kennedy, and put it up on this site, because even in the printed word, it will convey a lot of what she’s feeling. And not to say that she’s right about what she’s saying, but it’s definitely her perspective, and it’s well worth hearing.

It’s always curious trying to unravel what makes someone who’s struggling with something as serious as PTSD snap, and do something irreversible. Recently in the news we had the story of Eric Acevedo, another four tour of duty Marine who killed his girlfriend in Saginaw, Texas. As I blogged about earlier on this site, here, once I did a little digging into Acevedo’s backstory, I realized he had seen some horrific things in his third tour of duty. Three days after I posted about what I found on this blog, here, the Marine Corps purged the information off their site, as I learned from a reporter at the Dallas Morning News, who contacted me to tell me that my links were broken. Hmmmn.

This time, I pulled up the Eric Acevedo blog entry again, linked here, wondering if the hard times he’d experienced were anything near in time to the hard times Travis Twiggs experienced. It turned out they were only a few months apart – October and December, 2005 – in Iraq – and both of them “snapped” recently, to use the vernacular. If you delve into the topic of PTSD at all, you will learn that many people have a delayed reaction to what they experience, especially if they’re “medicating” themselves with alcohol, drugs, or workaholism – they can essentially keep the pain and possibly the memories at bay for years. (That’s part of why PTSD screening needs to happen at intervals after a servicemember returns from combat, to catch the experiences that happen later on.)

In the material Travis Twiggs wrote about his own battles with PTSD, he shares that he definitely mixed alcohol and medications, and weaning himself off alcohol apparently improved his situation for a time.

But now let’s splice in to the conversation what we learned from Kellee Twiggs, about her husband’s struggles. These are some of the elements that stood out to me, with observations included, where appropriate.

Kellee Twiggs says that her husband was in and out of three locked psychiatric facilities – aka, mental wards – in the last six months to a year.  She brings this up to say, I’m not sure why he was still out and about, working, driving, etc., during the times between those – in other words, he was really sick.

Definitely. But it also calls into question why the Marine Corps Gazette published what amounted to his “success” story back in January, 2008, which we talked about here (Includes a link to the original article).  At least in the non-military publishing world, one of the first things you’d want to vet before publishing a victory story in print, is that the person is still overcoming or still succeeding at whatever they were doing – otherwise, it’s embarrassing for all concerned. Did the Marine Corps Gazette not know he was struggling? From what Kellee Twiggs is saying, he was in and out of locked psychiatric wards during the same time period that article was published as his overcoming story. I’m personally still glad they printed it – I think it served to give people hope – but I have questions about why they did that, if they knew that he was still in the midst of valiant struggles with PTSD. At the very least, they should have checked, and maybe written a caveat – like, at press time, Twiggs appears to be relapsing, but we wish him all the best with his continued recovery.

• She says that at one point, he was on 19 different medications for PTSD.  Obviously, this isn’t a good thing. She mentions that his treatment fell short – overmedicating him and locking him up in a psychiatric ward just turned him into a zombie, and didn’t “fix” what was wrong with him. Agreed. Her preference would have been to have him treated at a special facility in New Jersey, but perhaps her impression of that is overhyped, and it too might not have been able to help.

I think what Kellee is on to is the fact that nobody really knows what medications to put someone on for PTSD. There was even a report going back a few years now that that’s one of the things that should be studied first, is what works and why. I know I’ve seen an article in print about a young servicemember’s struggles with PTSD, and his telling the tale that he went to the doctor (most likely at the VA), and whoever he saw, gave him essentially a bag full of pills, and said, try this, try that; we’re not really sure what works, so you figure it out – see what you think is helping.

Obviously that’s not a good solution, however true it might be. And given how many drugs interact poorly with one another, or cause other symptoms, a 19 drug cocktail isn’t in anyone’s best interests, or even sounds like good practice. If that’s what really happened to him, it does sound pretty bad.

• She says that Travis Twiggs was seen at Quantico, not by a doctor, but by a Physician’s Assistant (“PA”) who was known to be “their expert” in PTSD. She has a comical remark where she says, essentially, the Marine Corps is a huge, worldwide operation – you meant that they can’t either spend the money for a doctor or find one who’s qualified?

Again, if this is the case, that is pretty shocking. There needs to be a higher standard of care than that.

• In a TV interview with Kellee and her older daughter, Ireland, 8 or 9, soon after Travis Twiggs’ suicide, her daughter talks on camera (a surprising move, in general) and says how hard it was for her dad to lose the guys in his platoon, blogged about here – “especially when one passed away in his arms” (I’m paraphrasing). Wow. If that’s what really happened – and I wonder why anyone would have told her if it wasn’t – that’s also a level of trauma even beyond being around the guys when they died. From what I’ve read elsewhere, and blogged about here, it sounded like the two guys in his platoon who died on his third tour – one died instantly and the other died in the combat hospital later that day. Either way, it’s heavy spaghetti – all the more so if how it happened was quite that personal. I can’t picture why the daughter would think that unless it were true – sounds like something an adult would have told her, so that she could better understand the difficulty of what her dad was going through.

The Wounded Warrior Regiment connection. Later press reports made much of the fact that Travis Twiggs had been working with the Marine Corps’ Wounded Warrior Regiment, and had in fact met President Bush a few months ago, hugged him and said how willing he’d be to go back to Iraq for the president. I’m not going to touch the politics of this with a ten foot pole, but given how badly Travis Twiggs was struggling with PTSD, both before and after – that sounds to me like something someone says as much to convince himself as whoever he’s talking to. Obviously a noble, big-hearted guy, who wants to do the right thing. But a realistic read on how able he was to do that? Not so much.

A much more interesting aspect to the Wounded Warrior Regiment red herring – which in turn circles back to the topic at the beginning of this post about just what causes someone to finally snap is this.

I wrote elsewhere on this blog about my trying to get in touch with Travis Twiggs by email at the beginning of March, and also the Marine Corps Gazette, in order to republish his story in full, and how I never heard back. My sense is he was struggling hard with PTSD then, and it caused everyone to back off from wanting further publicity for his “overcoming” story, since it was starting to seem like it had holes.

But here’s something very telling. In one of her interviews, Kellee Twiggs talks about how much her husband Travis enjoyed working with the Marine Corps’ Wounded Warriors Regiment, and in turn, how much the guys in the regiment enjoyed or adored him. Perfectly understandable so far. Many people who knew him talk about what a great guy he was, and what a huge heart he had for others. But watch what comes next.

In one of her earliest interviews with a reporter late last week, Kellee said that her husband had been promoted to Gunnery Sergeant, but then stripped of his rank (I’m paraphrasing) when it became apparent that he was continuing to struggle with PTSD, and demoted to Staff Sergeant.

I had heard that little factoid early on, but not connected it with any other part of the story, still wondering why he went AWOL from the Marine Corps on Monday, May 5^th, and then showed up in Arizona, a place his own wife didn’t realize he had plans to visit.

Then it turns out…

She says Travis was doing much better, working with the Wounded Warrior Regiment, and getting back in the groove of responsibility and discipline and interacting with his guys. He thought he had been put in charge of the group, and perhaps he had, or was already functioning in that capacity, awaiting official confirmation.

Then, suddenly, a few weeks ago, according to Kellee Twiggs, the order came down that he was not to work with the Wounded Warrior Regiment, not to be their company gunny, and basically this was the moment when Travis snapped, and started struggling violently with PTSD again. Potentially because it was also the moment when Travis Twiggs felt like the Marine Corps has lost confidence in him. What happened next – going AWOL, showing up in Arizona, the armed carjacking, the 130-mile police chase, ending in murder-suicide, I have to say, it sounds very much like Travis Twiggs hit his own personal wall.

This was a man who was obviously very much caught up in the Marine Corps culture of “one for all and all for one.” The most devastating psychic injury he’d suffered, that he talked about at least, was the death of two young guys in his platoon, on October 27, 2005. In his essay on struggling with PTSD, published in January, 2008, he talks very transparently about fears that he had disappointed his command. This seems to be a guy who is extremely concerned with perhaps the external manifestations of leadership – and is heartbroken when he feels he’s failed either his guys that he leads, or the ones who lead him.

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At one point in the interviews, Kellee Twiggs says, in the most grief-stricken of ways, how crushed she is that Travis Twiggs died, leaving their two beautiful girls to grow up without their dad. Almost as if to say, “Was Travis not thinking about how painful that was going to be?”

There’s a well-regarded Australian study that we blogged about here that shows, at least with a rigorous, long-range study of Vietnam veterans, that CHILDREN of combat veterans who suffered from PTSD are at a much higher risk for suicide and other psychological struggles than are their peers. I’m sure that wasn’t exactly what was on Kellee’s mind when she said that, but it’s part of the heartache. The Twiggs’ “two beautiful little girls,” Ireland and America (love the names, seriously) now do have to grow up without their father, and probably will never understand the pain and torment he felt on likely a daily basis. And they will run the risk of feeling abandoned by him, in a very real way.

But the problem is, I believe, by the time that Travis Twiggs died, what was on his mind was essentially saving face with the Marine Corps, and how he’d lost his role. That would explain why his wife, who seems in every interview we see of her, to both love him and be a reasonable person, under the circumstances – to not have heard from him for two weeks, to not know that he was headed to Arizona, and of course to wonder how he (paraphrasing) could not have been thinking of her and their daughters when he killed himself. My sense is, he probably had his situation with the Marine Corps much more on his mind at the time, as sad as that may be to say. It doesn’t mean he loved them less, but it does mean, in his self-respect for himself as a leader, he may have felt that he’d finally lost the opportunity to lead, and experienced this as a fatally crushing defeat.

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There’s always the possibility that in potentially unfamiliar territory – Arizona desert, which certainly shares some visuals with Iraq – at the level of hallucinations that it sounds like he experienced – that during the car chase with police, that he might have flash backed to Iraq, and lost his contact with reality. It would be interesting to learn whether he was driving (or whether his brother was), and from the couple who was carjacked, which of the Twiggs brothers seemed to be leading and who was following, or whether they were both pretty well matched. It probably doesn’t matter in the long run, though, but it would, as they say in the legal biz, speak to Travis’ state of mind at the time.

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I’ve already blogged somewhere else about how it doesn’t sound all that relevant that “they didn’t leave a note.” Since the authorities blew up the large bag they were traveling with, on the offchance it was booby-trapped, no biggie. Any note might have blown into smithereens. But leaving a note also indicates presence of mind, and in Travis Twiggs’ wild, PSTD-fueled ride, it sounds a bit mutually contradictory or unlikely.

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There’s been a certain amount of crappy reporting that I would imagine is hard for the family to stomach. The initial press reports talked about both brothers’ “violent criminal histories.” Huh? If that’s not true, it should be retracted. No proof was ever provided, and that tangent never got developed. When Kellee talked in her interviews about the pain she felt hearing her loving husband portrayed as a monster, I couldn’t help but think of that remark, publicized quite heavily at the beginning of last week. See this media report, linked here, as evidence.

Of my two other least favorite reporting moments with this story, one was the leading question asked by the television reporter to Kellee Twiggs, on what looked like her porch. “Here, grieving widow, microphone stuck in face (I’m paraphrasing) – who do YOU think killed Travis Twiggs – the Marine Corps?” Yikes. Give the lady a little room, and don’t put words in her mouth, even if you think that makes for good television. Seemed like a low moment in shallow or manipulative reportage, just to get the quote.

Another was Tucson, Arizona KOLD 13 news producer, Stephanie Johnson, referring to the Twiggs brother's "crime spree" in the Grand Canyon, linked here.  Wasn't sure whether they also knocked over a liquor store or passed bad checks in the gift shop while they were there, but seriously -- doesn't a "crime spree" imply more than a single event (the carjacking)?  It just seemed pretty ridiculous, and inflammatory for the sake of being inflammatory.

And not in the news department, but just in the generally offensive department, as soon as "Travis Twiggs" started being a popular search on the Web last week, someone at AOL Live Journals threw up a porn site, liberally sprinkled with "Travis Twiggs" name in the metatags, and it shot up in the Google page ranks, to about number six -- even though the violent porn had nothing to do with Twiggs himself. And talk about offensive to the grieving family.  Very deliberately manipulative.  Fortunately, the editors at AOL's Live Journal caught the porn in time and disabled the links.  Grotesque how people attempt to profit off someone else's huge misfortune/tragedy.

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Well, on that cheery note, perhaps you'd like to hear some good news -- some of the POSITIVE things that rolled in about Marine Staff Sergeant Travis Twiggs, from those who knew him before he died, in an attempt to flesh out the picture we have of him, and/or set the record straight.  Here are a few:

From his neighbor, and landlord, who I believe is a prominent international philanthropy official in the Washington, DC area:

Having known Travis Twiggs and his family for 2 years, they rent a house we own near Quantico , my wife and I firmly believe the real story here is not about a chase/suicide. The real story is captured in the link right at the beginning of your article which most people won't open.

The real story is how this war, and PTSD devastates lives and families. The real story is also how the Marine Corps blew it.

Contrary to the impression given, Travis Twiggs was a very good man. One had just to watch him interact with Kellee and the girls, or see him jump in to help his neighbors to know this. He loved the Marine Corps. He'd often get up pre-dawn to work out to ensure he stayed in shape.

While he was at Bethesda Naval Hospital I would occasionally e-mail him with words of encouragement. The first time I did it I said, "I hope you don't mind". It took a while for Travis to respond. He said he couldn't get to a computer often, but my words "meant more than you'll ever know".

Travis loved his family and loved the Corps. That is what we will always remember [about him].

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From one of his social workers, who treated him at Quantico:

Staff Sgt Twiggs was seen by me at Quantico for many months and treated for his TBI/PTSD. He was an honor to know and to work with. He served our country with many deployments to Iraq and Afghanistan and served his men and led them well. The trauma and death he experienced is a very common story by our military people coming back. Many do not appear to be harmed because they have no "visible" wounds. However for those of us in the Mental Health field that work with the men and women who serve in the Military every day, know how deep these wounds go. Staff Sgt. Twiggs was given the best medical treatment the USMC has to offer. We stood by him and loved him and were committed to his recovery everyday.

What the Public needs to understand that our men and women coming back from this war suffer on many levels and some just can not come back from their experiences. Staff Sgt. Twiggs served his country up until the moment he died. I knew him very well and he was running from his deep, deep pain and I am grief struck that his story ended this way. Please, Please know this is but a very sad moment in a mans life who was a Hero and an Awesome and very loved Marine. Please think of him in this way and not by the end of the Story. Honor him please as I will do the rest of my life. He was a blessing to know and I was very honored to have shared in his life for as long as I could. Please honor all of our military who serve this country. They deserve you respect, your love and your support.

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From a family member (in-law):

T-Bo was a loving brother, son, husband and father not to mention a loyal and dedicated Marine. This I can vouch for.

Editor's Note: If you haven't done so already, spend a few minutes watching the raw video footage of the interview with Kellee Twiggs last week.  It's quite good, and gives you a renewed appreciation for how hard Travis Twiggs was struggling with PTSD, before he died, and how much his wife and family loved him.  That blog entry is linked here.

"Hidden Wounds of War" Conference in LA

This weekend, the Soldiers Project holds its "Hidden Wounds of War" conference in LA.  See link for more details.  The theme of the conference is "hidden wounds of war: pathways to healing," and conference speakers will focus on everything from the impact of war on the servicemember and his or her family, to the challenges facing therapists who counsel them.  The speakers will include:

• Jonathan Shay, M.D., Ph.D., longtime veterans advocate and VA psychiatrist;
• Congressman Bob Filner (D-CA), chairman of the house Veterans Affairs comittee;
• Harriet Katz Zeiner, PhD - Lead Neuropsychologist, Polytrauma Rehabilitation Unit, VA Palo Alto;
• Jimmy Castellanos - OIF Veteran, student at Claremont McKenna College;
• Paula Domenici, PhD - Deployment Behavioral Psychologist, Center for Deployment Psychology, National Naval Medical Center, Bethesda. Co-Author - Courage After Fire: Coping Strategies for Troops Returnng from Iraq and Afghanistan and Their Families;
• Helena Young, PhD - Clinical PTSD Program Manager, VA Palo Alto; and
• William Saltzman, PhD - Professor, Educational Psychology, Administration & Counseling, California State University Long Beach; Assistant Director, Project Focus Program, UCLA

Editor's note: For a link to the Soldier's Project, click here.

Twiggs' Wife: "The PTSD Drove Him Crazy"

Wow...well, for a truly excellent experience, see this raw footage by Arizona TV reporter Suzanne Kennedy, interviewing SSgt. Travis Twiggs' wife, Kellee.  It's great stuff.  Kellee Twiggs speaks her mind, the reporter asks fairly good questions and leaves Kellee plenty of room to talk, and it's long -- which means you get quite an opportunity to hear from Kellee about what Travis Twiggs was going through recently, and how she felt about it.  Really excellent work.  It also clears up a lot of the mystery about what the last few months of Travis Twiggs' life was like, and reinforces the impression we probably already have, about how the Marines are still quite a bit better at fighting wars than they are at tending to the needs of their warriors, and how Twiggs' guilt over losing several men from his platoon weighed on him heavily, and didn't resolve.  Kellee comes across in a great way, and it's very sad at the end of the tape, when she breaks down talking about how much she misses him.  In the rest of the tape she's very composed, under the circumstances, and makes an impassioned advocate for better psychological care for the troops.  Here's the link to the excellent raw interview footage; if it becomes available as a video to embed, I'll add it here as well.  Great work.  Click here for the link.  (See also this later blog entry, linked here, which includes a transcript of the interview.)

Editor's Note: Elsewhere today we've learned that Kellee and her husband, Travis, go way back: they were childhood neighbors in Louisiana, and had been married for nine years, with two children.  That's another way of saying, she really knows the guy, and what's "normal" or "abnormal" in his behavior.

Bleeding Green with PTSD

It's been fascinating watching the groundswell of deserved nationwide interest in the SSgt. Travis Twiggs story, and seeing some of the pieces come together about who he really was, and what he'd been struggling with.  It's also been heartening to hear from some of the people who know him, who truly want the larger story told -- a story that the major media is pretty much determined to miss.  If you're someone who served with Travis Twiggs or knew him, and you have stories, pictures or video to share, please email me and let me know what they are before sending them.  Perhaps we can put something together for his wife and family so they can have a great memory of their husband and dad, now gone.  I'll also go ahead and post in this entry any decent reporting I find or things I run across that put his story in more context.  Thanks for your help on this - maybe together we can put together a nice tribute to who Travis Twiggs actually was, before he lost his last difficult battle with the ultimate wartime insurgent, PTSD.

The PTSD Obituary for Travis Twiggs

In a separate entry that I'm working on as often as I can stomach it, I'm putting together what I'm starting to think of as Travis Twiggs' obituary from PTSD, linked here.  In reality, no one writes lengthy obituaries of non-famous people, and somebody who died in a blaze of probably self-inflicted gunfire, after an armed carjacking and a multiple day police chase, is probably really unlikely to receive one.  Not to mention, there really is no such thing as a PTSD obituary, but maybe there should be.  The verdict is still years away on whether we think, as a society, that combat veterans who die from PTSD are also worthy of special honor -- say, a purple heart -- and initial results do not look promising.  (See survey on Military.com, linked here, which at least last night was registering only about 31% of votes as positive ones.)

There's something very Bonnie and Clyde -- or at least, Clyde and Clyde -- about Twiggs' premature, violent death.  It brings back memories to me at least of the end scene in that famous 70s classic, "Butch Cassidy and the Sundance Kid," with Robert Redford and Paul Newman, in an era when either one would have qualified for People magazine's "Sexiest Man on Earth" (a magazine contest they'd yet to invent.)  In the end scene, as I remember it, outlaws Butch & Sundance have escaped to Bolivia, are convinced they're pretty much surrounded by the Federales, and plunge off the cliff, armed and together, in a basic "F.U." move to those who are in pursuit.  (This classic cinematic ending is replicated later, chick version, in "Thelma and Louise.")

We don't, of course, know what the heck Travis Twiggs and Will Twiggs were thinking, on their escapade, and how fully planned out their exit was, or whether it just came to them at the time, and they winged it.  We don't know what Will Twiggs, from Louisiana, was struggling with, that got him involved in this particular endgame, but we do know enough about Travis Twiggs' story to know about his struggles with PTSD.  That's at least a partial answer.  (Update: from what Travis Twiggs' wife, Kellee, has said publically, it now sounds a little bit like Will Twiggs may have been going along with Travis Twiggs to keep him company and to watch out for him, and they both had announced plans to visit ailing relatives in Louisiana.  But they were in Arizona.  It really doesn't make sense yet, and maybe never will.  News reports point out that they apparently left no suicide note; at the same time, authorities blew up a large bag they had with them, on the off-chance it was booby-trapped -- so if they did leave a note, but it was in the bag, well, that's long gone as well.)

What made them journey to the Grand Canyon, half a country away from either one of them, pack -- according to press reports -- large backpacks, and then carjack a couple's 2008 car when theirs got disabled, before leading police on a multi-day chase, ending in gunshots (allegedly, the Twiggs brothers died in a murder-suicide, possibly with Travis shooting his older brother, Will, then killing himself).  Some press reports, and all of them are minimal, suggest that the Twiggs guys headed out to the Grand Canyon to die -- with the strong possibly of driving their car off a cliff -- but then when their car was disabled, they carjacked the other car, to have transportation.  If that's true, the backpacks make no sense at all.  In any case, they're gone, we're not going to learn anything more, and the best we can do is put together the pieces of what we do know, which when it relates to Travis, has an awful lot to do with PTSD - a condition he fought, talked about, and ultimately -- we believe -- succumbed to.

Why take the time to tell his story, at all?  Given the way that he died, and initial press reports that suggested a long-term, violent criminal history for both Twiggs and his brother (we have no idea if this is true or not, but Travis Twiggs spent enough time in the Marine Corps this doesn't make a whole lot of sense - it may just have been a mistaken impression, given the carjacking.)  Well, if you'll excuse the informality of expression, I'm writing this because I think it pretty much sucks that he died, and I'm very sorry that he took himself out, for reasons best known to himself, but which nevertheless are somewhat easy to understand.  Here was a guy who for whatever reason, could never forgive himself for what he saw, did or experienced in combat -- particularly the loss of the lives of the guys who died on his watch. He wrote about it, plagued himself with it, prayed over it, and ultimately, couldn't come to terms with it.  It may not have been the only thing bothering him, but it's obvious from his story that it was significantly bothering him.

If, through a rhetorical device, we combine phrases from letters he wrote to both of the guys, we hear him saying this:

"I want you to know that not one day has passed since "I" lost you. I wish that I could erase that horrible day from my memory...but I can't. I feel responsible and always will for not bringing you both home. I miss you, brothers."

Was Twiggs' death in Arizona ultimately an attempt to erase that memory from his mind?  We believe that it was (among other things), and mourn his passing.

Travis Twiggs' Suicide - Only Questions Remain

About USMC SSgt. Travis N. Twiggs' recent apparent suicide in Arizona with his brother, Will Twiggs, so little is known that really only questions remain. Don't look to the way-less-than-mediocre coverage of his death by the national news media, it's essentially not even there.  If you find anything at all, it'll be the same basic, scant details of a very small story, repeated endlessly by one outfit after another, adding nothing new, shedding no actual light on the subject.  In situations like this, you don't even have to be a Taoist to realize, sometimes the questions that are left are more profound or thought-provoking than the actual facts that we know.  And since he apparently didn't leave a note, this is all we have to go on.

Here's what we do know, and it's admittedly not enough -- then, later, the questions.  (I may have to update this throughout the day, b/c it's just taking too long to write.  I feel like I'm writing his damn obituary, after all -- in case no one else ever does.  Or at least one that reads a little bit between the lines, and gives perhaps a fuller picture of who he was.)

His full name was Travis Nathaniel Twiggs.  He was 36 years old, which makes him born in 1972, give or take a few months.  He was recently an active duty Marine, at Quantico, although it's possible, according to delayed news, that he may have been AWOL from Quantico since May 5th.  He served five tours(!) that we now know about, one in Afghanistan (OEF), four in Iraq (OIF), most recently in Fallujah.  By February, 2006, he was back in the U.S., because he was doing a little PR on his own time, delivering a flag that had flown in Fallujah to the Thor-Lo sock company in Statesville, NC.

His background with the Marines was this: SSgt Twiggs enlisted in the Marine Corps in 1993 and went through recruit training at Marine Corps Recruit Depot Parris Island. He served as an 0311, infantry rifleman, and deployed to Afghanistan for Operation ENDURING FREEDOM in 2002 and three times in support of Operation IRAQI FREEDOM between 2003 and 2006.  In one of his most recent deployments, to Fallujah, he was part of 2nd Battalion, 6th Marines, Company G, part of 2nd Marine Division, II Marine Expeditionary Force, based at Camp Lejeune, N.C..  In October of 2005, he lost two guys in his battalion -- Robert Eckfield, Jr., and Jared Kremm -- a loss that would painfully stay with him always, perhaps along with others.  Back in Quantico, VA, he served as Infantry Weapons chief at the Marine Corps Warfighting Laboratory.  At one point, he was a course instructor for the Marine Corps Martial Arts Program or "MCMAP" Instructors' Course, and taught it to a group of Marine Corps reservists in New Orleans, LA.  (That's the group pictured, above, with Twiggs on the far right.)

On the personal side, we know this.  Twiggs was married -- his wife, Kellee, very unfortunately says she only learned of his death through an Arizona tv news report; it sounds like she thought he and his brother, Wills, were on a roadtrip to visit relatives in Louisiana, and had been out of contact for some days.  They have two daughters -- Ireland, 8, and America, 4.  (If you know anything about PTSD, you know it isn't easy to be involved with someone who has it.  They can be -- not saying Travis Twiggs was -- unpredictable, explosive, and generally draining to be around.)  He had at least one sibling, Will Twiggs, full name Willard Jay Twiggs, the man who died with him in the apparent murder-suicide (which they now suspect was Travis killing his older brother, and then turning the gun on himself.)  It sounds like his brother Will may have been along for the ride, so to speak, trying to take care of his brother and watch out for him in his struggles.  But we don't know.  Twiggs' father understandably refused to speak with reporters about his sons' deaths.  His wife said that he was a "wonderful husband, and a great Marine" (you can almost hear the emphasis in that sentence); and that he "bled green" for the Marine Corps. 

If you don't count Afghanistan and Fallujah, plus other places in Iraq, we know that Travis Twiggs lived in at least the following places: Florida (Sunny Isles Beach, Lake Worth and Lantana); Louisiana (Metairie and Ama); North Carolina (Jacksonville and Midway Park), South Carolina (Beaufort) and Virginia (Stafford); and probably most recently, Stafford, Virginia.  He died in Arizona.  It's unclear where he was born, or what local paper will eventually publish his obituary.

The Statesville, NC newspaper, the Statesville Record & Landmark, which previously published an article by reporter Chyna Broadnax about Twiggs' visit to Thor-Lo on the paper's website, and has since inexplicably removed this article from its archives, is featuring the hard-hitting article "Showers Likely, Thunderstorms Possible" as today's top story, but making no mention of Twiggs or his death.  If you manage to find an archived copy of that earlier article, you'll learn that Loren Simpson, Thor-Lo's director of sales, spent three weeks with Twiggs in Baghdad a few years ago while he was deployed, apparently getting up close and personal with active duty troops to figure out how to make a sock that better suited their specific needs.  (In case you weren't aware, comfortable combat boot socks are a big deal to servicemembers, and Thor-Lo clearly went the extra mile to customize their product.)  Then Thor-Lo generously donated socks to outfit his battalion.  When Twiggs returned stateside, he presented Thor-Lo's president, Jim Throneburg, with a flag flown over the American Combat HQ in Fallujah as a gesture of appreciation, in a celebration it sounds like the whole company turned out for.

Later that year, in October, Twiggs was yakking it up in the Marine Corps' Quantico Sentry, in an article by Lance Corporal Justin P. Lago, about just how much he loved on-base spinning classes -- to the point of taking two a day.  Hmmn.  That's a little extra-intense, for anyone's purposes, even a Marine: although it is known that exercising large muscle groups, like the legs, helps to burns off strong, aggressive emotions like anger better than other exercises do.  (I got that little factoid from a great British book on mental wellness, Free Yourself from Harmful Stress, by Trevor Powell -- linked here.)  Two spinning classes a day suggests he may have felt he had a whole lot of stuff needing to be burned off, since I highly doubt he was a male anorexic.  (Later on, he was equally vocal in his enthusiasm for martial arts training, and the "help" it gave him in dealing with his PTSD.)

What makes him signficant to us is that Twiggs was the first Marine we knew of who courageously and openly published an account of his struggles with PTSD in the Marine Corps Gazette, in January of 2008.  (The Marine Corps Gazette archives unfortunately seem to be limited to just subscribers, but you can find that article in at least two places on the Web, in full: here and here.)  Marines aren't typically known for their radical openness about weakness and struggles, for any number of reasons.  It's part of the mystique, the brand, and what makes them "cool" -- and Marines seriously ARE cool -- but, it's also pretty much of an occupational handicap.  If you want to read more about this topic, read Kathy Dobie's great piece in the Nation, from a few months ago.  It's called "Denial in the Corps," and I blogged about it here.  (That also includes a link to the actual story.)

Even though I found Twiggs' own story a little too prematurely rah-rah about his recovery from PTSD -- PTSD is notoriously difficult to "kick," and many old vets out there wish they could say they're free from it, despite years of struggle -- I knew he was breaking truly important ground by talking about his struggles so openly.  What he did could help many others, who needed to hear that message from someone else who served.  If you know anybody in the military who's struggled with combat trauma, you know how much they prefer hearing the truth from someone else who knows it -- someone who's been where they've been.  Twiggs was providing that hugely important resource to others.  If you read  between the lines of his essay, you can tell he's still pretty tortured -- by the memories of the guys he lost, by the questions that wracked him, about whether he had done enough (seriously, not a good question to obsess over, since it's never going to resolve positively, except to forgive yourself for whatever happened.)  He dedicates his essay, almost as an afterthought, to the memory of Lance Corporals Robert F. Eckfield, Jr., and Corporal Jared J. Kremm, two guys who were obviously still very much on his mind.

Both Lance Cpl. Robert F. Eckfield, Jr., 23, from Cleveland, Ohio, and Lance Cpl. Jared J. Kremm, 24, of Hauppauge, N.Y., died on October 27, 2005 from an "indirect fire explosion'' in Saqlawiyah, Iraq, according to the military.  Kremm died at the scene of the explosion, and Eckfield died of injuries later at a battlefield medical center where he was evacuated.

If you're wanting to get really heartbroken about stuff, you can read on the Web, I won't say where, notes that Twiggs wrote earlier to these guys, in their memory:

"Jared -- I want you to know that not one day has passed since "I" lost you and Robert. I know that you are safe now and in a better place, but at the same time, I want more than anything for you to be back here with your family. Kellee and I pray daily that your family has found some sense of peace. I miss you brother." -- Twiggs Family of Quantico, Va.

"Robert -- I just finished writing a letter to Jared and it applies to both of you as does this one. I know you are at peace where you are, but I wish you were here with your family and your lady. I wish that I could erase that horrible day from my memory...but I can't. I feel responsible and always will for not bringing you both home. Kellee and I pray daily that your family can find peace. I miss you brother."  -- Twiggs Family of Quantico, Va.

Tom Ricks, well-known military correspondent and author of various books including Making the Corps, wrote a brief article in the Washington Post on January 6, 2008, mentioning Travis Twiggs' essay on PTSD that had just been published in the Marine Corps Gazette.  Ricks introduced it by saying, "People sometimes talk about the sacrifices made by U.S. troops without grasping just what that means."  He hoped that by sharing some of Twiggs' pain, torment, and yes, also moments of victory with his readers, that more people would be able to do that.

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What happened in the months leading up to Travis Twiggs' death?  I'm not sure we as the larger public will ever be privy to that.  It sounds like Travis was in and out of psychiatric facilities in April, and had possibly gone AWOL on May 5th.  At the beginning of March was when I tried contacting him several times at various email addresses, and also the Marine Corps Gazette, to see about reprinting his essay in full, in case it could help more people.  I never heard anything back, from any of my attempts, and even though I had his cell phone number, which came through in one of the auto-replies to my emails, I didn't think to call it because I didn't want to intrude.  But my guess was the no contact back from him or the Gazette meant he wasn't doing too well and didn't want to talk about it, which is understandable.

By the end of today (Thursday, May 15) a Phoenix television reporter had reached Kellee Twiggs by phone at the Twiggs home in Stafford, Virginia.  She sounded both aggrieved and ticked off as she said about Travis, "He was sick, mentally, with PTSD. and this is the result of it.  He now leaves me, and two beautiful daughters, because NOBODY in the Marine Corps, here at Quantico, wanted to take the time..." and there the sound clip ended.  In another interview, this one in print, which may have been part of the same conversation, she elaborated, "All this violent behavior, him killing his brother, that was not my husband. If the PTSD would have been handled in a correct manner, none of this would have happened."

For someone like Travis Twiggs who intimately knew the ravages of PTSD, and had tried to warn his fellow veterans about them (see his writing on the subject, and a particularly good quote about it, linked here), it's very much a tragedy that it ultimately took his life, or at least ground him down to the point where that's what he saw as a solution.  As we learn more about what Travis Twiggs went through in combat, what we may find is that the human being, no matter who he is, is just not that durable or resilient to endure or bounce back from repeated assaults on their psyche, especially when they happen back to back.  People may just reach a breaking point, no matter what their training or their level of resolve.  It may turn out that people can handle some combat trauma, but not back to back deployments filled with heavy amounts of it, as the type of warfare veterans have experienced has been changing.  It may just be too grueling for many people to handle without something inside them snapping, after which they sadly really never are the same.

If you read between the lines of Travis Twiggs' own story about PTSD, it sounds like things just got harder and harder for him, and the light that he saw at the end of the tunnel, queue the old joke, wasn't quite illuminating the exit, but was from the oncoming train (continuing PTSD).  Think of how little the average person is going to know about Travis Twiggs' "before" picture -- including people in Arizona who are only learning about him through the carjacking and his violent death.  There's so much more to his life, his family, his sacrifice -- things people will never know, outside of his friends and family and people who served with him.  But not to talk about the broader picture, just to capsulize him in the shorthand of wire service news reports as just some whacked-out guy, perishing in a shootout off the highway, after leading police on a 130-mile chase -- does him and any other combat veteran who has seen and done too much -- a real disservice.  Want to "support the troops?"  Then learn more about what they actually go through, and the toll that it takes on them and their families.  And if all you learn about them is the two second newsbyte about them on their way out the door, realize there's much more of a previous history than you're likely to learn, and some of it is very important to know.  Of all the things I've learned about Travis Twiggs, the one that's going to stay with me is not how he died, but his literal anguish over the death of two of his men, which seems to have broken something deep within him.  Whatever comes of this whole episode, let's just not compress the impact of his life into the last few days or even weeks of it.  It has to have been so much more than that.

In the immortal words of the wonderful poet, e.e. cummings, "...for life's not a paragraph, and death i think is no parenthesis."  The impact that Travis Twiggs was starting to have about healing combat trauma -- "I pray that no Marine or sailor, or any servicemember for that matter, ever has to go through what I went through -- needs to keep on going, despite his own personal exit.  RIP, Travis N. Twiggs.

The Ballad of Travis Twiggs

I'm personally still reeling from the apparent murder-suicide of USMC SSgt. Travis N. Twiggs and his brother, Will Twiggs, as the cops closed in on them in Arizona yesterday.  (See umpteen shallow news reports for the same basic information, but no explanatory context or any insights as to why.)  Our previous blog entries about Travis Twiggs are here, here, here and here.

While I make my feeble attempt to sort through what is known and what is not, and blog about it later, I'm struck by one comment Twiggs made in the essay he published about his own signficant struggles with PTSD.  The comment is specifically about PTSD:

"I pray that no Marine or sailor, or any service member for that matter, ever has to go through what I went through." -- Travis N. Twiggs, RIP, 5/14/2008.

RIP Travis N. Twiggs, USMC PTSD Sufferer

Very sad just breaking news in the USMC Staff Sergeant Travis N. Twiggs story we blogged about yesterday.  See link for details.  It sounds like authorities who were searching for Twiggs and his brother, wanted in an armed carjacking in the Grand Canyon on Monday, learned that they just killed themselves as they were being surrounded by police in Arizona today, in a potential murder-suicide (though no one is speculating who killed whom at this point). The real tragedy that you won't necessarily learn about elsewhere, is that Twiggs, one of the few Marines to come forward and write both convincingly and publicly about his significant struggles with PTSD.  He was the the author of an article called "PTSD: The War Within, A Marine Reflects on His Struggles with PTSD," that was published in the January issue of the Marine Corps Gazette, and noted in an article by Washington Post correspondent and military historian, Tom Ricks. Click here to read a copy of that original article by Twiggs, whose recommendations must now of course be considered in light of his subsequently tragic, self-inflicted death.

While several elements in Twiggs' realistic but optimistic story cast doubt to this writer on whether he'd actually overcome his demons, his words undoubtedly gave hope to many, and provided a flesh and blood example of a combat veteran who truly understood.  It's with great sadness that we note the literal "end" to the Travis Twiggs story.  We hope that the five(!) tours of duty he gave his country as a Marine, first in Afghanistan, and then four more in Iraq, are remembered more than his untimely and tragic end.   And we hope that much greater attention will be paid to the cumulative effects of back-to-back deployments and lifetime total load of triggering exposure to the things that cause PTSD.  RIP, Ssgt. Travis Twiggs.  You gave what you had to give, both before and after combat.  It's just a very sad tale that it had to end this way.

Mark Twain had a famous line about truth needing to be stranger than fiction, because fiction at least needed to observe some sort of structure in order to make sense.  In that light, there's a particularly, to me, poignant end to Twiggs' own article.  He tells his guys -- the ones he knew, and the ones he didn't yet -- "My e-mail is [omitted], and I will help anyone in need."  That's a great, kind statement, and particularly sad in light of the realization that Twiggs himself apparently wasn't able to get all the help he needed, either.

Editor's Note: If you want to learn more about who Travis Twiggs was, go to this longer entry, linked here. 

PTSD - "The War Within" - Claims Another Victim

How quickly, it would seem, one can go from badass to bad apple, when PTSD is involved.  USMC Staff Sergeant Travis N. Twiggs, please, say it ain't so.   I so want to believe this is a case of mistaken identity, or that somehow out there might be several Travis Twiggs, roaming America, with their country music star-sounding names.  But at this particular moment, that just seems more than a tad unlikely.

Some background.  On January 8th and then again last month, on April 23rd, we wrote about Travis Twiggs on this blog.  (See entries here and here.)  Twiggs is/was a USMC staff sergeant, from the 2nd battalion, 6th regiment, company G, who had served four(!) tours of duty, one in Afghanistan, and three in Iraq, including most recently in Fallujah.  That's a photo of him on the left, from about a year ago, touring a plant in North Carolina, and thanking them for sending his guys specialized socks in Iraq (Thor-Lo).  I've cropped the photo but he's talking with a seamstress at the plant, and he presented the company with a flag that was flown in Iraq to thank them for their support.  All good so far.

His story initially came to my attention because Washington Post columnist and well-known military author Tom Ricks wrote about Twiggs briefly in January.  Twiggs has been forthcoming about his battle with PTSD, and has told his story compellingly, most recently in the Marine Corps Gazette, in January of this year, in an article entitled, "PTSD: The War Within.  A Marine writes about his PTSD experience."  I wanted to secure Twiggs' permission to retell his story in full on this blog, in his words, but although he attached his email address to the article, and other email addresses have surfaced, no reply was forthcoming to my email requests.  Nor did the Marine Corps Gazette respond.  This, and some things he said in his article, both gave me pause, and made me wonder -- was his story really such a resounding success after all?

Fast forward to the tragedy part of this.  (If you do a people search for Travis Twiggs, you really only find one, nationally, who's his age, 36, so it seems pretty clear this is one and the same person.  From the photos, you can tell that there's also more than a slight resemblance.)  Today my blog statistics were spiking high and it made me curious to see what search was being run.  Cut to the chase: people were looking for news about Travis Twiggs.  And why?  Well, it turns out he's suspected of carjacking a couple's vehicle in the Grand Canyon, there's a manhunt underway for him and his brother, who's suspected in the same crime, and they're both considered armed and dangerous.  News coverage mentions that he's a ten year military veteran (they don't say he's a Marine), covered with tattoos, who suffers from PTSD and is known to behave erratically.

It is heartbreaking to read this news.  What gave me pause about Twiggs' original story?  Two main things.  He attributed, somewhere I read, a signficant portion of his "cure" to spirituality.  Spirituality, while significant to those who believe in its importance, is really an adjunct to treatment, not the treatment itself.  Seriously.  The other reason was, he credited another significant portion of his improved mental health/recovery essentially to working out.  I left that out of the part I quoted, because it just rang so hollow.  Working out is great.  It's an effective, known way to disperse aggression, create feel-good hormones, and increase positive self-esteem.  But in no way, shape or form is it meant to be a cure for PTSD.  It is, again, a part of an effective personal coping strategy.  These two issues created doubts in my mind; the third doubt was planted by Twiggs and the Marine Corps' completely dead silence in response to requests to reprint his article.  On the off-chance he really was doing well, better than expected (and I very much wanted to believe that), his words could have helped many, many people.  However, the lack of response created an impression that perhaps the recovery was oversold, or somehow premature. If you rave up a cure, but you're really not there yet, you definitely want to distance yourself from those words in print when you later on turn out to be struggling.  Very understandable, if that's the case.

I'm so very sad to learn about this armed carjacking.  I very much hope it's not the same person at all.  And I hold out faint hope that even if it is, that it can still work out "well" -- but who knows what "well" would look like at this point.  Prison doesn't sound like fun OR a cure; or even an effective place to get treated for combat trauma.  Marines are in many ways, the best of the best.  (Marketers sometimes joke that the Marines have one of the strongest "brands" in America.  Truly they do.)  They're amazing warriors, but they also can have a habitual reluctance, borne in part by what they do for a living, so to speak, to admit weakness, when and where it exists.  Twiggs made a mighty attempt to admit the weakness he felt, by publishing that initial article, and by taking the rest of the steps he did, to try to get well.  As we have the opportunity to study the effects of combat on veterans, especially in light of combat trauma and PTSD, it's going to be increasingly important, I believe, to take a look at two things, among others, both of which affect Twiggs' own situation.  How many times you've served (which includes length of deployment and time off in between) -- in Twiggs' case that was four -- and what went on when you were there.  Twiggs was in Fallujah, at least on his last deployment.  What happened to him there, and did anything that happen there have bearing on what happened next?

Come to think of it, right at the beginning of Twiggs' own story, he talks about being sent back into combat after already experiencing too much.  That has shades of the Eric Acevedo story as well.  Heartbreaking.  When will the time come when we care as much for the warriors, like Twiggs, as they have cared for us -- by serving?  Sadly, that question is still rhetorical.  Wherever you are, Travis Twiggs, I hope it goes well with you, as much as it can, under the circumstances.  The responsibility for what you're going through is actually shared.

Homeless Veterans: Still Hidden in Plain Sight

The plight of homeless veterans may not be making the news right now as it did around Thanksgiving -- but one thing's for certain: they haven't stopped being homeless in the meantime.

Recently, Homeless Veteran Provider Technical Assistance Center listed our blog as an excellent resource -- thank you.  Note the wonderful illustration at left, done by veteran activist and artist John Paul Hornbeck, creator of the "Shattered Soldier" lifesize sculpture about PTSD, blogged about earlier, here.  John's revisions to the famous POW/MIA flag says quite kindly about the homeless veterans among us, "You Are Not Forgotten Either."  If only that were really the case -- perhaps over time we as a society can make it so.  (He's also cleverly changed "MIA" to mean, "Missing in America," pretty much the same as, "missing in plain sight" -- since clearly the homeless, and homeless veterans in particular, are everywhere, whether we choose to tune in and notice, or not.  (To see more about John Paul Hornbeck's "Shattered Soldier" sculpture, click here, here or here.) 

If you want to learn more about the plight of homeless veterans in America, start here, with the Homeless Veterans Fact Sheet, produced by the National Coalition for Homeless Veterans.  The fact sheet discusses statistics for both homeless veterans and incarcerated veterans.  And the statistics paint a grim and sorrowful picture.  According to statistics supplied by the U.S. Department of Veterans Affairs (VA), the nation's homeless veterans have been historically mostly males (though those figures are likely to change, with the advent of more women serving in the military). 

The vast majority are single, most come from poor, disadvantaged communities, 45% suffer from mental illness, and half have substance abuse problems. America’s homeless veterans have served in World War II, Korean War, Cold War, Vietnam War, Grenada, Panama, Lebanon, Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom, or the military’s anti-drug cultivation efforts in South America. Forty-seven percent of homeless veterans served during the Vietnam Era. More than 67% served our country for at least three years and 33% were stationed in a war zone. (Editor's Note: observe the connection between substance abuse and/or mental illness and homelessness. More work needs to be done to study other predisposing factors to homelessness, including PTSD and Military Sexual Trauma.)

The National Coalition for Homeless Veterans also has a good, web-based list of service providers -- programs that are geared towards homeless veterans.  Click here for that link.  They say they periodically update their website by adding more programs as information becomes available, but right now you'll only find organizations listed in the following handful of states: California, Indiana, Massachusetts, Maryland, Minnesota and New York.  (Click on any of those states' names to go right to the information available on their site.)

Hey Mama: Celebrating Mother's Day for Veterans

Happy Mother's Day to the mothers who've served in combat, and to the mothers, stepmothers, grandmothers, and adoptive or foster mothers of those who've served, not to mention the wives and girlfriends of combat veterans.  The veteran pays a heavy price for his or her sacrifice; but so do the generally unsung heroines on the homefront.  They're the ones struggling to make sense of the distance and loneliness; trying to hold down a job to keep the family afloat and tend to the children as well; and they're often called upon to pitch in as 24/7 caregivers or patient advocates when the need arises after injury.  Some of these women who we know personally are truly amazing role models, and due an enormous debt of gratitude and respect.  However, they're ALL worthy of appreciation for the mighty roles they fill.  Let's hope this Mother's Day they get just some of the gratitude they deserve.

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One veteran's mother, Frances Richey, did something unusual.  She wrote a book of poetry about being the mother of a son at war, called The Warrior.  Amazon.com, in its product description, calls it "A heartwrenching and powerful memoir in verse from a mother grappling with the reality of her son at war in Iraq."  Richey, a single mother, raised a son who went through West Point and became a Green Beret, serving multiple tours in Iraq.  Recently, the Seattle PI wrote an article about the book, called "Mother's poetry illustrates the pain she felt while her son fought in Iraq."  Click here for a link to the book, and here for a link to the article in the Seattle PI.   

No Surprise Here: Recovery is Expen$ive

USA Today has a story in today's paper about the surging costs associated with veterans care, linked here.  This should come as no surprise to anyone who's been following the topic for the last several years.  Today's veterans are sustaining severe, disabling injuries and they seem less reluctant than their predecessors were to know about or file for the benefits they're due, which is a good thing.  Studies like the recent one from the non-profit Rand Corporation, blogged about here, and books like The Three Trillion Dollar War: The True Cost of the Iraq Conflict, by Nobel prize-winning economist, Joseph E. Stiglitz and Harvard's Kennedy School of Government professor Linda J. Bilmes, taken together show both the number of veterans affected, as well as the cost of caring for the wounded for the rest of their natural lives.  The USA Today article suggests that, according to the VA's own estimates, almost 1/4 of OIF/OEF veterans have filed for some form of disability: 181,000 of 755,000 veterans, which is a pretty substantial portion.  However, the payout to individual veterans is usually anything but huge.  If you've read stories like Army veteran Tony Neff's "All I Want is What I Deserve: A Soldier's Own Story of Service, Injury and Neglect," blogged about here earlier, you've seen the hardship money actually involved.  It's not exactly a "get rich quick" scheme for veterans, who can often not even pay their bills based on the disability pay they receive.  Not to mention, combat injuries like PTSD can make it hard to hold down a job, keep a marriage or a family together, or stay in school.  Truly, the costs are staggering, and it's not surprising that they continue to climb.  That said, as a society, we have no other choice but to pay them, and not with reluctance, either, as a tribute to those who served.  Fair is fair.

Editor's note: I'm curious to know whether military contractors' future disability payments are included in these totals or not; and whether they become part of the Tricare or VA system's healthcare delivery program after they return.  They typically earn much higher pay than deployed military, an understandably sore subject to veterans who serve alongside them; but, contractors are often sometimes former military who are returning to a combat zone after several deployments.  Either way, the injuries are piling up and getting more expensive, and in cases like PTSD, cumulative exposure to combat increases the risk of developing the disability.

The Katz Email: Can We Just Call "Bullshh!it"?!

By far the most distressing revelation from the lawsuit by veterans against the VA, currently making its way through Federal court in San Francisco has to be the toxic email, disgracefully titled, "Shh!" and written by Ira Katz, M.D., the VA's top psychiatrist, about the not-exactly-light 'n humorous topic of veterans suicides.  The email essentially attempts to cover up the severity of the number of veteran suicides that are taking place by those who are undergoing treatment at the VA.  The contents of that email by now are fairly well known -- and the general reaction is to Katz's words, not surprisingly, is revulsion.  Senators Patty Murray (D-WA) and Tom Harkin (D-IA) are two legislators calling for Katz' removal.  There's been just enough stink about his ill-chosen words that Katz has been moved to make a very superficial apology for them, a la Roger Clemens.  An article in today's Seattle PI, linked here, quotes CBS News as saying Dr. Katz now calls his word choice "unfortunate."

Erm, well, can we just call "bullshit" on this?  Because, really, it's more than the choice of words people are reacting to -- they're sensing the specious and supercilious attitude behind them.  In the immortal lines from Oliver Wendell Holmes, "Even a dog knows the difference between being kicked, and being tripped over." 

The "Shh!" email brings to mind another bureaucratic bumbler of late, Michael Brown, head of FEMA during the Katrina crisis, who ostensibly fiddled while Rome burned, writing superficial emails to his colleagues preening about his choice in ties and lamely wondering if it was time for him to go home yet. "'Can I quit now?' FEMA chief wrote as Katrina raged," according to an article archived here on CNN.com.

Brown certainly seemed to be over his head (no Katrina puns intended) at FEMA; perhaps Katz, because of his psychiatry training is actually not.  However, they both have a world of learning to do in how to project empathic leadership.  There's nothing confidence-affirming about either one of their responses. Wounded warriors deserve a lot better from the top psychiatrist at the VA responsible for their care.  Those aren't just poorly-chosen words, there's an attitude of callous disregard for the patients behind them as well, that no thin veneer of apology really corrects.  Combat veterans struggling with alarmingly high and well-documented rates of PTSD and suicide need compassionate leaders with a vested interest in their care, not someone making light of the size and the severity of the problem.  In anyone but a psychiatrist, whose field after all is mental health, we might find this easier to understand or excuse.  But in a psychiatrist whose professional responsibility is the mental health of veterans?  Absolutely not.  That's a vote of no confidence, in someone who's sworn to uphold the Hippocratic oath to "first, do no harm."  The bumbling and apparent cluelessness of FEMA's Michael Brown in the face of a huge need for crisis management and control spurred calls for him to resign; perhaps outrage over Katz' email will do the same.  There's really no way to spin that into a positive.  The damage has already been done.

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Here's the content of the email Katz titled "Shh!" for those who haven't seen it.  According to the article in the Seattle PI, "Our suicide-prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities," Katz wrote in a Feb. 13 e-mail to Ev Chasen, the department's communication director. "Is this something we should [carefully] address ourselves in some sort of release before someone stumbles on it?"

"Abandon Hope, All Ye Who Enter Here..."

It sounded like potentially good news for veterans and their families at the time, but I'm wondering if it ever really happened.  Human guides were proposed to lead wounded veterans through the maze of healthcare.  On November 1, 2007, the Kaiser Daily Health Policy Report published a news item called "DOD, VA Team To Provide Care Coordinators for Servicemembers, Veterans."  These "Federal Recovery Coordinators," as they were termed, were established "to help veterans with health care and recovery." 

According to the Kaiser Daily Health Policy Report, the Department of Veterans Affairs and the Department of Defense would establish “federal recovery coordinators” responsible for helping guide wounded servicemembers and veterans through their health care and recovery.  Apparently this was an idea introduced by the Dole-Shalala Commission, although it also could be a common sensical approach conceived of by any overburdened friend or family member of an injured veteran.  The concept was that ideally these coordinators would not just aid their clients in navigating the healthcare options available to them, but also produce better coordination between the two departments, Defense and Veterans Affairs.  Strangely enough, the goal to have ten coordinators trained and ready to go by January, 2008 -- a mere two months later -- and in place at the largest veterans healthcare installations. 

It's mid-2008, and I don't know about you, but I've not heard another thing about this.  Do they exist?  Was the plan scrapped because it was too ambitious or otherwise untenable?  Are they out there, but keeping a very low profile?  Inquiring minds want to know...

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This is what the Kaiser Report said at the time:

The departments of Defense and Veterans Affairs on Wednesday signed an agreement to establish "federal recovery coordinators" who will be responsible for guiding wounded servicemembers and veterans through their medical care and recovery, the Washington Post reports. The recovery coordinator position was a key element of a presidential commission's recommendations to help improve health care services for military members and veterans returning from the wars in Iraq and Afghanistan (Vogel, Washington Post, 11/1).

The coordinators will be responsible for overseeing care coordination between the two departments' health care systems, and they will assist family members as well (AP/Contra Costa Times, 10/31). The first 10 coordinators, who will be provided by VA and trained by January 2008, will be assigned to large military health care facilities. Michael Dominguez, principal deputy undersecretary of defense for personnel and readiness, in a statement said, "This agreement will help ensure our nation's wounded warriors and their families receive the care they need and deserve at the right time, right place and by the right person across the continuum from recovery through to their reintegration into their communities" (Washington Post, 11/1).

All we want to know is, then what happened?

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Editor's note: for all the non-literature majors in the crowd, the title comes from Dante's Divine Comedy, and is supposed to be what the poet imagined was written over the gates of hell.

Dr. Ecstasy Will See You Now

An article in yesterday's Sunday Times (London, UK) talks about the drug, Ecstasy, as having therapeutic potential for treating severe, unremitting PTSD.  The article, which is titled "Ecstasy is the Key to Treating PTSD," by Amy Turner, is linked here.  The drug in question is more properly known as MDMA, or 3,4-methylenedioxy-N-methylamphetamine, pictured here.

The article says that MDMA's potential therapeutically wasn't noticed until 1976, "when the American chemist Alexander Shulgin tried it on himself. He noted that its effect, “an easily controlled altered state of consciousness with emotional and sensual overtones”, could be ideal for psychotherapy, as it induced a state of openness and trust without hallucination or paranoia. It quickly became known as a wonder drug, and began to be used widely in couples therapy and for treating anxiety disorders. None of these tests was “empirical” in the scientific sense – no placebos, no follow-up testing – but anecdotally the results were almost entirely positive."

The therapeutic potential for treating PTSD is apparently to be found, according to the article, "in the trust it establishes."  One researcher familiar with the drug, quoted in the article, states:

“Many people with PTSD have a great deal of trouble trusting anybody, especially if they’ve been betrayed by someone who abused their trust, like a parent or a caregiver,” he says. “MDMA has this effect of lowering fear and defenses. It also allows more compassion for oneself and for others. People can revisit the trauma, feel the original feelings but not be retraumatized, not feel overwhelmed or have to numb out to cope with it.”

This is obviously good news for PTSD sufferers.  The study is still in its early phases, and the reality is, that if PTSD is able to be treated with one or just a few doses of MDMA, versus potentially years of psychotherapy and/or lengthy courses of pharmaceutical antidepressants, etc., this news is likely to be welcomed more warmly by patients eager to get well than by healthcare providers who previously expected to be providing maintenance doses of psychotherapy and/or pharmaceutical care for years to come.

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The formal study analyzing MDMA's therapeutic effects on PSTD is being conduced by Michael and Annie Mithoefer, under the auspices of MAPS, the Multidisciplinary Association for Psychedelic Studies, linked here.  While this might sound like a highly "hippy dippy" research project, the reality is, the other day I called a research group at the University of Arizona's Department of Psychiatry, and listened to a recorded message about a trial of psilocybin and OCD.  (See article, linked here.)  Mainstream medicine is apparently, if only slightly, open to studying the therapeutic uses of controlled substances.  In the meantime it's important to note that the street drug, Ecstasy, which may or may not be based on MDMA, depending on the purity, is not a substitute for taking part in a clinical trial like the Mithoefers', and there is always considerable risk in attempting to self-medicate any serious health condition, especially with illicit drugs.  Read the Sunday Times article, linked here -- it's quite informative.  And keep track of this ongoing research, which looks promising for some sufferers.

Editor's Note: In a feeble attempt at true-to-life humor, this was the license plate I saw recently on a very nice, late model Acura, parked in the driveway at a state veteran's home.  Perhaps it was just a visiting DJ.

The Doppelganger of PTSD: the Unwelcome Stranger Who Follows You Home from War

Over time, more and more grassroots efforts spring up as veterans try to help one another deal with the effects of combat trauma and PTSD.  Some of these are simply conversations, where those who went share what the experience was like, and how they've suffered since -- and ideally, also what they've been able to do about it that helps.  The Peoria Journal Star in today's paper has an article about just such a conversation, held by local central Illinois veterans in conjunction with a traveling exhibit of the Vietnam Wall.  The article is short but poignant in the reminiscences shared by predominantly Vietnam veterans about how combat trauma and resultant PTSD has changed their lives, and not for the better.  Click here for the link to that story. 

There's nothing particularly "extraordinary" or "dramatic" about these men's PTSD or their comments about it -- but that's the thing.  They've very representative of what actual people go through who weren't expecting the experience to scar them for years after combat.  Just one example: a combat photographer with a Ph.D. talks about his own experience. "Divorce, alcohol, drugs, jail, attempted suicide ... I've done them all," he said.  If combat trauma is the stone thrown into the pond, just think of the ripple effects of every item he just mentioned.  Sadly, combat trauma affects not only the participants, but also many of the people in their lives.  Recently I received an unsolicited memoir from a former Marine and Vietnam veteran about his experiences with war and PTSD, and on practically every page the same thing ran true: the enormous remorse and regret he felt from the pain he'd inadvertently inflicted on his family members, because of what he was going through at the time, and couldn't cope with.  Combat trauma, left untreated (and we don't mean, with drugs and alcohol ;-), can become the uninvited guest in far too many veterans' homes and every family gathering.

The German word "Doppelgänger" or "double-goer" comes to us from literature, but seems to have some application with what veterans go through as well.  The Doppelgänger is a person's double, often but not exclusively seen as an evil twin, and often in ominous contexts (premonition of someone's death, etc.).  But in the straight meaning of a connected but separate other self, a veritable "double" self, it conveys what some veterans seem to go through.  The memory of war they've experienced is so profound and powerful, it's permanently "attached" to them.  When they return to society, and have to "re-integrate," the combat self actually never leaves them, and this seems to produce a lot of the pain that they feel.  They frequently acknowledge being "permanently changed" by war -- but yet when the war is over, or when they come back, they're expected to integrate back into society, and into the lives they formerly led.  Many veterans talk about how almost no attention is paid to this experience by the military: you come back, and have to figure this part out for yourself, but it can be deeply troubling.  You can't shake the person you became in war -- in fact, it's always with you, as a "second self."  But at some point you have to come to terms with the fact that both those selves are you, and there is no separation.  In a lot of the pain you hear, see and feel from Vietnam veterans as they share about their experiences, you get a very profound impression that they are in fact feeling shame (and yet connectedness) with the person they became because of war, as well as a desire to protect their loved ones, however incapably, from that very person.  Tremendously, what you also see is a deep desire for other, more recent veterans to profit from their experience.  The "older brothers" (and sisters, but it's mostly men) want their "younger brothers and sisters" not to have to experience the tremendous pain, ostracizing, and neglect they felt -- as well as the inability to come to terms with what it meant.  The Vietnam veterans seem to have a deep, and laudable, desire to become the "readjustment counselors" for today's OIF/OEF veterans.  However, their own healing has to take place first -- and from the expressions of deep pain that get conveyed, you can tell how difficult that healing really is, and sadly, how infrequently it's been able to take place.  (True healing, after all, means going through the pain, processing it, and integrating it into the whole self.  Many people accomplish a "form" of superficial healing, which turns out to abandon them later, by masking over the pain with other "drugs," from drugs and alcohol, to social isolation, to even workaholism, to keep the pain at bay.)

Although we need to write more about this topic separately, even "workaholism" can be a drug to suppress painful memories and experiences.  This "drug" is better suited to some than others -- probably the 'Type A' types "enjoy" it most -- but it's effective as far as it goes, which of course is never quite far enough.  I heard an amazing story from a veterans service officer the other day about the most elapsed time he'd ever seen between someone suffering from combat trauma and realizing he had PTSD.  That's referred to as "delayed onset" but check out how delayed it really was, because of workaholism, most likely.  A World War II veteran, 84 years old.  Had fought in Normandy, Ardennes, the Battle of the Bulge.  He felt he'd led a "blessed life," and had in fact just retired (at 84!).  But in his retirement, with all sorts of unstructured time on his hands, started experiencing nightmares, and would wake up, having soaked the bed.  The nightmares were about what he'd experienced, over 60 years ago(!!!), but which he'd finally had "time" to start bringing up from the vault of memory.  And he was suddenly in terrific psychic pain from this.  Although I applaud the amazing things this man must have done during the intervening 60 years to consider he'd led a "blessed life," I can only wish that he'd also been able to find some healing during that time as well.  Experiencing delayed onset PTSD in your mid-80s, from battle you saw in your 20s, must be a terrible thing indeed.  It's also another reminder about how combat trauma continues to affect veterans from all wars.  And how extending compassion, wisdom and healing to veterans from every war is part of what we ought to be doing, as a society, and often do quite minimally, if at all.

Know Your Benefits: Get the VA Handbook

The Department of Veterans Affairs has published its annual resource handbook, called Federal Benefits for Veterans and Dependents.  It details the benefits programs available for eligible veterans and their families.  The handbook is a bestseller for the Government Printing Office, which makes hardbound copies of the book available for a fee ($5), or you can download the 153-page book in its entirety as a PDF on the Web (you must have Adobe Acrobat installed, but that's free.)  Click here for the downloadable PDF copy on the Web.

(If you need to order a hardbound copy of the book, you can do that by contacting the Government Printing Office at the following address: Superintendent of Documents, P.O. Box 979050, St. Louis, MO 63197-9000 (stock #051-000-00233-4).  You can also order the book online by clicking this link.  The Government Printing Office accepts credit cards at their toll-free number, (866) 512-1800.  The cost is $5 a book or $67 for 25 copies.  The stock is #051-000-00233-4.)  (Obviously, the downloadable version of the book is free on the Web.)

The good news is, most veterans do qualify for some VA benefits.  As we noted recently in a previous blog entry linked here, often veterans are slow to realize they qualify, for a number of reasons, and this slows down the process of getting them the benefits they have actually earned.  Don't be one of those vets -- order the book today, or download a copy, and keep it on file for the future, if not for today.

Kathie Costos, Chaplain

Kathie Costos, also known as "Nam Guardian Angel," is a certified, ordained Chaplain and member of the International Fellowship of Chaplains ("IFOC").  The daughter of a Korean War veteran, and the wife of a Vietnam veteran, she has been active in veterans issues since the 1970s.  For the last 25+ years, she has focused on Vietnam veterans with Post-Traumatic Stress Disorder.

As a chaplain with a devout Greek orthodox background, Kathie nevertheless believes that "no matter what church people belong to, they belong to the family of God as God's children."  Years of volunteering with Vietnam veterans and their families has taught her to take care of the spiritual needs of people and not just the already "faithful."

Kathie is the author of a well-regarded book, called For the Love of Jack, His War/My Battle -- about how her family coped with the legacy of PTSD that her husband returned with from the Vietnam War.  She self-published the book immediately after 9/11, out of concern that the word needed to get out about what PTSD was, before many more people began to suffer from it.  The book is available for downloading on her website, and Kathie has also produced many educational videos about PTSD that are also available on her website.  A list of those videos include the following, but because Kathie is always expanding the list of videos she's made about this topic so close to her heart, it also makes sense to "favorite" her on YouTube, where a list of all her videos is linked, here.  A list of those videos current as of this writing include the following (each is hyperlinked to YouTube or Google video, so you can watch them directly):

• Wounded Minds: PTSD and Veterans (Google)
• Coming Out of the Dark: PTSD and Veterans
• When War Comes Home, Part One
• When War Comes Home, Part Two
• Hero After War
• Death Because They Served - PTSD Suicides (Google)
• Wounded and Waiting, Part One
• Wounded and Waiting, Part Two
• Women At War
• The Voice, Women At War
• Nam Nights Of PTSD Still
• PTSD After Trauma
• PTSD Not God's Judgment
• Homeless Veterans Day

A link to Kathie's website about PTSD is here.  For a direct link to the book she wrote about her husband and family surviving PTSD, click here. For a link to her ever-expanding list of videos about PTSD and veterans, click here.

A favorite quote of Kathie's: "The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive veterans of early wars were treated and appreciated by our nation." -- George Washington.