Healing Combat Trauma

PTSD: (That's Some) Pretty Terrible Sh*t (to Have to) Deal (With), Don't You Think?

Editor's Note: We commemorate the otherwise momentous, historic signing of the GI bill into law today with this little snippet of what life was like for someone who served recently.  For everyone who doesn't "get" what sacrifice is, and that those who've served have earned their accolades and rewards, here's a grunt's-eye view of the experience of combat trauma, and how that relates to PTSD and various other topics in the news.  It's doubtful that any one of us would like to have changed places with him, at such a young age.  Herewith, his story, emphasis mine:

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I'm no Vietnam vet, but a vet of Operation Iraqi Freedom. I turned 18 while in boot camp because I graduated high school at 17. I was discharged early for having "personality disorder" after I went to Iraq.

I was in the Marines, and my MOS was a ground communications electronics technician. A couple months after graduating my training for the job and going to my first unit, I was "volunteered" to join and train with another unit that was leaving soon. The new task I was given was "Mortuary Affairs".

This group was put together with a couple dozen other Marines from other sections. Our job was to go to locations where troops had been killed and not able to be retrieved by the group they were out with due to the fact they were under too much danger or whatever the case. I had no clue the effects this would have on me. It was a horrible experience.

It was not like going and picking up a corpse and that's it. For one, you were in a hot zone, where people were just killed, not just by gunfire.

Here are some brief descriptions of the missions I was a part of...
 

The first one wasn't too bad; the body was actually brought to us at the camp we were at.

 

It was a young male Marine. He was supposedly in a Hummer going somewhere and might not have been wearing his helmet. He had a silver dollar sized hole in the side of his head.

When we get the bodies back the camp we have to take off all materials on the body, and go through and bag each individual body part. It was more of a surreal experience really, I did not know how I was supposed to feel.

Once our troops invaded Fallujah was when things started to get worse. On another of the missions, a truck carrying fuel was crossing a bridge and was shot with an RPG. The truck went off the bridge and fell, the fire burning most of everything.

 

When we went out it was usually just a dozen of us with maybe 2 Hummers of security if we were lucky. For anyone who doesn't know, most the Hummers used were old and poorly maintained/equipped... almost no armor. So we get there and head down to the bottom where the truck fell and we had to pull out burnt bodies from inside of the cabin.

 

It sounds bad, but burnt bodies are almost like burnt food... so perhaps it wasn't as bad as the rest. It did not help our appetite when we had to eat in the same building we processed the bodies in. Our shop was just a medium-sized bunker, no walls or anything so yes we basically ate next to the bodies. It is obvious why some of us didn't eat the meat.

 

The worst mission I went on was when an army tank was traveling down a road and was blown up from a roadside explosive. The bomb was so powerful: you could not identify ANY part of the tank except for the tracks. It had been tossed a couple hundred feet in different directions.

 

It took us I think, about 15 hours to do this mission. There was gunfire when we first arrived but nothing more. I think we picked up a couple thousand pieces of flesh that day. Going through each one individually. They would range from small penny-sized pieces to legs, torsos, heads, feet, testicles, arms, etc.

 

There were a few more missions but we get the idea by now I'm sure. I guess it started to become noticeable that I wasn't doing well. I was taking whole boxes of NyQuil tablets and drinking bottles of medicine to get anything I could out of it at night. I smoked probably a pack of cigarettes a day, which is a lot for me because I have never really smoked more than a couple cigs a day if at all.

 

My officer had me go speak to the chaplain and from there a navy doctor who was a great person to have over there. He pulled strings and had me med-evac'd out of there a few weeks later.

 

In the meantime I had been moved out of my job until I was able to leave. I was harassed for leaving: superiors thought I was just faking to get out.

 

I had become highly depressed and my roommates noticed me screaming sometimes in my sleep.

 

From Iraq I spent a few days at an army hospital in Germany, talking to various doctors and such... going through the process.

 

I was being given pills for depression and for insomnia. Then I made it back to the US and once at my base I was seen by a psychologist. They actually gave me the option to get of the military, so I did.

 

I had been told the process takes several months to year until you finally leave. In the meantime I started drinking daily, and stopped taking the pills they gave me because they seemed to numb my mind and I could not stand it because I have always had such a wonderful and creative mind. It made me feel like a zombie, I could not even create artwork which was my biggest hobby.

 

A month down the road I started having nightmares, very detailed and morbid. A few times I would wake up with tears. I began having suicidal thoughts and crying at least a few times a day. Thank God my best friend was stationed not so far, he saved my life I think.

 

It was hard for me to wake up because of the medicine I had been taking, that’s another reason I stopped it, I was always drained. The first week I was back I never even reported back to my old unit, I didn't know what I was doing.

 

A week later they send somebody to come get me. There, I was harassed and treated like a piece of s%#t some more by my master sergeant. They had me sit in inventory room all day while I struggled to stay awake. I luckily had a very kind staff sergeant in charge of me at the time. He would let me sleep and go home early.

 

I admit I was very lucky in getting out, because it only took me about 2 months until I was officially a civilian again. I was going back home. I stayed with my older sister and her boyfriend at first, because I was not too fond of going back to my parents. My depression got worse and I started to drift further from sanity and comfort; people noticed I was a different person.

 

At this point I started smoking marijuana occasionally. Which was really the only time I felt anything, happy, able to think, speak, talk to people, feel normal.

 

Eventually I moved back with my parents and that's when things got worse for me. I had some additional problems I know was facing, I needed a job, and had people on my back constantly. I had no access to marijuana during this time.

 

My insomnia got to its peak to where I could not sleep AT ALL at night. I also began having more suicidal thoughts, nightmares got worse and I had them ANY time I could sleep which was usually from 7:00 AM to 12:00 PM, began having auditory and visual hallucinations everyday, and constant anxiety.

 

I knew I had PTSD and that the military used "personality disorder" so that they would not take the rap for it.

 

I finally couldn't take the insomnia anymore and was prescribed Ambien, which actually works extremely well and helped get my body back on schedule, only thing is I had to take it for 3 months and then no more because they said it was addictive.

 

So it became difficult without it. I did a long process of seeing doctors and filling out paperwork for the VA and was finally officially a disabled vet due to chronic Post Traumatic Stress Disorder, normally referred to as PTSD.

 

I started to be able to get a hold of marijuana again and when I had it things were more stable. My temper was not out of hand and I could sleep comfortably having less nightmares. At this point I had gone a year or more straight of having nightmares every night.

 

It has been three years now and I am much better. Time has healed me a little and I smoke marijuana as often as I can. I don't have hallucinations anymore, or rarely any nightmares. I do however still have bad anxiety, temper, and depression problems when I'm not high.

 

Another thing I forgot to mention is that PTSD has basically ruined my memory. Since I first showed symptoms until now, my memory does not work nearly as well as it should.

 

I still have major problems concentrating and working sometimes too. It makes interviews and other social activities near impossible for me, as I cannot speak or express myself as I used to. I get very nervous and my mind blanks out sometimes. I cannot say if marijuana will help all my problems, but I can say marijuana helps me feel alive.

 

Being high is the only time I feel good and happy, deep down. I can be around loved ones or any social crowd without tweaking out from anxiety, I can think and operate much more smoothly, I don't have a short temper, and it makes me want to live.

 

The past couple months have been rough on me and I have been going to the VA hospital here to try and get help. The first 4 times I went, they did the same exact thing which was to ask a series of questions, ask me if I want pills and send me home. I kept telling them I did not want pills because I have seen what they have done to people I know and what they have done to me.

 

All I wanted was someone to talk to.

 

After the fourth time of going in there feeling like I wanted to die, they finally got someone for me to talk to. We have just met once so far, but I think it will be good for me.

 

In the meantime I have not been able to smoke recently because I am trying to find another job, which is not going too well and I only have a couple weeks before my current job ends.

 

I have had a few interviews but blow them miserably because it’s getting harder and harder for me to go through the whole thing without my nerves choking me to death. It’s only been a week or two since I smoked last and my temper and depression are already busting through the door. I worry too easily and stress out to the extreme.

 

Take what you will from this story, but I know for a fact marijuana has saved my life numerous times.

 

-- One young former Marine's story, in his own words. Used with permission.

Editor's note: "Mortuary Affairs" was also the detail highly-decorated Marine ("Marine of the Year") Daniel Cotnoir worked in Iraq, before a combination of circumstances, including PTSD, triggered an event in his hometown of Lawrence, Massachusetts -- which got him arrested, and barely escaped conviction.  We have blogged about Daniel Cotnoir's case many times on this blog, going back several years, when it was current.  It's safe to opine, that even within the trauma of war, some things are harder to endure than others.  Our guess would be, mortuary affairs really qualifies for extreme hardship and exposure to things that make PTSD an occupational hazard.

Robyn D. Walser, Ph.D.

Robyn D. Walser, Ph.D, is a psychologist for the National Center for PTSD at the Veterans Palo Alto Health Care System, California. Dr. Walser received her degree in Clinical Psychology from the University of Nevada-Reno. During her graduate studies she developed expertise in, traumatic stress, substance abuse and Acceptance and Commitment Therapy (ACT). She is currently developing innovative ways to translate science-into-practice and is responsible for the dissemination of state-of-the-art knowledge and treatment, related to Post Traumatic Stress Disorder, to health care professionals and trainees across all VA facilities nationally. She is working on a number of web-based and educational PTSD products for both practitioners and veterans. In addition, she is responsible for several research projects investigating use of mindfulness and ACT in PTSD populations, plus PTSD in the geriatric population. 

Robyn D. Walser, Ph.D. is also the author of Acceptance & Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder: A Practitioner's Guide to Using Mindfulness & Acceptance Strategies, along with her VA colleague, Darrah Westrup, Ph.D.. 

"Disposable Heroes" - Washington Times and ABC News Investigates Drug Testing on Veterans

On June 16th, the Washington Times, which has been following the "Chantix harm to veterans" story doggedly, and ABC News, produced an investigative piece called "Disposable Heroes," about the drug testing that takes place on veterans, sometimes with lethal consequences.   That interactive piece is linked here. (Ironically, earlier this week, we posted an entry about veteran' similar exposure, this time from the Vietnam War, that is still coming to light.  That post is linked here.)

Here's the lead from the Washington Times' story, by Audrey Hudson:

The government is testing drugs with severe side effects like psychosis and suicidal behavior on hundred of military veterans, using small cash payments to attract patients into medical experiments that often target distressed soldiers returning from Iraq and Afghanistan...

In one such experiment involving the controversial anti-smoking drug Chantix, the Department of Veterans Affairs (VA) took three months to alert its patients about severe mental side effects.  The warning did not arrive until after one of the veterans taking the drug had suffered a psychotic episode that ended in a near lethal confrontation with police.

If you want to find other entries in the Washington Times' extensive coverage of Chantix and veterans, use this link here, which will produce a list of the articles, or go to their website, linked here, and do a search for "Chantix".  Be forewarned, however. Although the information on the website is well worth learning, the Washington Times has an especially cumbersome user interface, irrespective of browser.  Get ready to enable popups, and then, even so, only be able to pull up the stories with great difficulty.  Someone really needs to improve that...)

Going Frantic over Chantix - Anti-Smoking Drug Causes Problems for Veterans with PTSD

An anti-smoking drug, Chantix, prescribed to veterans, including those with PTSD, has been linked to significant health problems:

The Washington Times reported on February 2, "Government regulators said the connection between Pfizer's anti-smoking drug Chantix [Vanericline] and serious psychiatric problems is "increasingly likely." The Food and Drug Administration said it has received reports of 37 suicides and more than 400 of suicidal behavior in connection with the drug."

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On May 16, the FDA issued a Public Health Advisory, linked here, about the drug, and mentioned -- of particular concern to those with PTSD -- that use of Chantix "may cause worsening of a current psychiatric illness even if it is currently under control and may cause an old psychiatric illness to reoccur." The FDA warned those taking Chantix about the "possibility of severe changes in mood and behavior," as well as about "vivid, strange and unusual dreams" -- problems already for veterans with PTSD. Similarly, the FDA described symptoms that Chantix might cause may include "anxiety, nervousness, tension, depressed mood, unusual behaviors and thinking about or attempting suicide."  Grrrreat.  Apparently, according to the health advisory, problems occurred both while taking Chantix, and during withdrawal.

Approximately a week later, on May 22, the Washington Times again reported that the FAA had banned Chantix for use by its pilots and air traffic controllers, after concerns about its use.

 

Congressman Filner on Health Care for Veterans

Closing remarks of Congressman Bob Filner (D-CA), Chairman of the House Committee on Veterans Affairs, on the momentous passage of the GI Bill.  While the rest of Congressman Filner's remarks addressed education, he also commented on veterans ongoing health care needs and concerns, here:

"Last year, Congress made the largest increase in veterans’ health care funding in American history, when we increased VA funding by 30 percent, successfully adding $12 billion more than the President’s request and $39 billion more over five years. The new GI Bill is an even larger fiscal commitment to our nation’s veterans - providing a quality educational benefit for those to whom we owe so much.

While we have made much progress, new challenges continue to mount. Tens of thousands of service members are being discharged from the military without adequate diagnosis or treatment for post-traumatic stress disorder (PTSD) and traumatic brain injury. Refusing to face this challenge, leaders at the VA have attempted to manipulate suicide data to portray a lesser problem. In addition, the claims backlog for VA benefits now totals well over 600,000. The VA also failed to protect our veterans when they became more involved with research than providing treatment - When Chantix, an anti-smoking drug, was linked to suicidal thoughts and aggressive and erratic behavior, the VA failed to immediately eliminate their testing of veterans, placing them under increased risk.

It is obvious that our work has just begun, and I will continue to fight to hold the VA accountable for their actions and provide the very best care to our nation’s veterans. I will work to transition the VA from Veterans Adversary to Veterans Advocate!"

-- Congressman Bob Filner, Representative for California’s 51st Congressional District, and Chairman of the House Committee on Veterans Affairs, linked here.

Editor's note: Regarding Chantix, we did a post the other day, linked here, which talks about how to learn more about the medications being prescribed for PTSD, and how to learn about possible interactions with other drugs, such as Chantix.

Needless Trauma: What Vietnam Vets Still Don't Know about Their Service Could Hurt Them

Saw this recent press release from a California congressman, who himself is a decorated Vietnam vet, and wondered about the pain that comes from NOT knowing the full extent of what you've been exposed to, as you were serving your country.  For the particulars, keep on reading:

– Today (June 12), Congressman Mike Thompson (D-CA) took another step toward helping veterans who were unknowingly tested with chemical and biological weapons in the 1960s and 70s.

The House Subcommittee on Disability Assistance and Memorial Affairs held a hearing on a Thompson-authored bill that would give these veterans health benefits and compensation for illnesses resulting from “Project 112” weapons tests. Thompson hopes this hearing will ultimately push his bill toward consideration by the House.

Project 112, which included ship-based Project SHAD, was conducted between 1963 and 1973 by the Department of Defense (DoD) and other federal agencies. The DoD now admits that during these projects, unknowing military personnel were involved a number of chemical weapon tests such as VX nerve gas and Sarin nerve gas and were exposed to biological weapons such as E. Coli, Tularemia (Rabbit Fever) and Q fever.

“First the government denied the tests existed. Then they said the tests happened but were harmless. Now they admit dangerous substances were used on our military personnel, yet they still refuse to give them care for their illnesses,” said Thompson. “We can’t change the past, but we can begin to right this wrong by giving these men the proper healthcare and compensation they earned.”

HR 5954, introduced by Thompson and Congressman Denny Rehberg (R-MT) in May, provides veterans of Project 112 a “Presumption of Service Connection.” This means the Department of Veterans Affairs (VA) presumes the relationship between service and a health condition, making the veterans involved eligible for medical benefits and/or compensation for their conditions. For example, veterans exposed to Agent Orange during the Vietnam War are already given a “Presumption of Service Connection.”

“I understand security classifications and the sensitivity of our operation,” said Jack B. Alderson, a retired Lt. Commander from the U.S. Navy Reserves and resident of Thompson’s district. “However, these were not volunteers but service personnel ordered to do a dangerous job and they did it, and did it well, now their nation needs to take care of them.”

In 1964, Alderson was the officer in charge of five U.S. Army light tug boats that were used to test chemical and biological weapons. The tug boats acted as sampling stations and targets for disseminated weapon clouds.

After the DoD admitted to Thompson that the tests did exist and included harmful agents, they released more than 6,000 names of military personnel used in the tests. However, the GAO reported in February that the DoD had halted their efforts to disclose additional names and many veterans remain unaware that they were even involved. The Thompson-Rehberg legislation would require the DoD to hand over all the names to the VA, which must then notify the veterans.

The Thompson-Rehberg legislation has been endorsed by the Vietnam Veterans of America, Veterans of Foreign Wars, American Legion, Disabled American Veterans and Paralyzed Veterans of America.

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CONTACT: Anne Warden at (202) 225-3311, (703) 338-4480 and anne.warden@mail.house.gov.

For a link to Congressman Thompson's office, click here.

PTSD Drugs: Better Living through Chemistry, or Purely Popping Pills for PTSD's Psychological Ills?

There was a story in the news recently about four young combat veterans in West Virginia, all seemingly in decent physical condition beforehand, who nevertheless all died in their sleep recently.  Besides combat PTSD, one thing the vets all had in common was the cocktail of drugs they were taking: Paxil, Klonopin and Seroquel.  (The Charleston, West Virginia Gazette-Mail reported this story on May 24, 2008 - it's linked here.)  An investigation is pending, but the story obviously raises the question: what are vets with PTSD being prescribed, and is it really working, or what's best?  (Continue reading, and you'll learn more about those specific medications as well.)

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Where to go for information about PTSD medications?  Here are a few, carefully-chosen selections, and their pros and cons - as appropriate:

Jonathan Shay, M.D., Ph.D., well-known VA psychiatrist and outstanding veterans advocate, has written before about medications used to treat combat PTSD, and his impressions of them.  He wrote the material for a lay audience, in the version that's kicking around on the Web, in several different locations, and although it has been quoted by many as gospel, it's more than 12 years old by now (first published in 1995), and that's much too much time that's elapsed to consider that information really current. (The Dr. Shay list, "About Medications for Combat PTSD,"  is linked here.)  So that information is interesting for background -- and particularly for Dr. Shay's explanation of how things work and/or what makes a good PTSD medication, and what doesn't -- it out of date and should not be considered current. 

There's another list on the Web -- a table, really -- that's much more current (2006), and it lists the drug names, brand names, and how the drugs are thought to work with PTSD.  That list is linked here.  It may be a little difficult to read if you're coming to the topic cold, but perhaps not.

Some other suggestions:

If you have access to a public library or academic library, you can check out the PDR -- the Physician's Desk Reference -- and read up on a drug's profile, side effects, warnings, etc.  But since you're already on the Web, we can assume, reading this -- try going to PDRHealth.com, linked here-- and read up on the prescription drugs prescribed for PTSD.  Of the three drugs mentioned earlier, Paxil is linked here; Klonopin is linked here; and Seroquel is linked here.  You can also do a straight search for any OTHER drug used in PTSD treatment, or one with possible interactions with a drug used for PTSD, at the same site, by searching within prescription drugs by name (e.g., Zoloft, Chantix, etc.), at the general search interface, linked here.

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But the information in the PDR, whether on the Web or in the desk reference, is going to dry and technical, though worth reading -- pretty much exactly like the fine print that's packaged with the medications themselves. What you're probably going to want to know more about is what in software is called "the user experience" -- how other patients like you have experienced the medications.  For that you will need to turn to some other sources.

For what amount to "user reviews," try PsychCentral, or Revolution Health, both of which have increasingly robust user communities who will comment on their own experiences of the medications.  (Of course, not all their users taking medications for PTSD have PTSD from combat trauma, so be aware that their cases may be substantially different.)  Combined with the technical information about the drug's effects, side-effects and warnings (see links, above), it might be helpful in creating a broader picture of what the user experience is like:

Dr. John Grohol's PsychCentral website:  Paxil (Paroxetene) is linked here; Klonopin (Clonazapam) is linked here; and Seroquel (Quetiapine fumarate) is linked here. A general search through the medication library is linked here.

AOL Founder Steve Case's Revolution Health:  Users in the "User Community" provide "Community Ratings" on various medications.  The items on Paxil, Klonopin, and Seroquel are linked here (click on any of those hyperlinks to take you to the community ratings), or, use a more generic search here, and look for the tab beneath that says "Community Ratings." (We will be blogging more about Revolution Health shortly.)

Don't forget books as well.  Mark Goulston, M.D.'s Post-Traumatic Stress Disorder for Dummies (2007), linked here, is very recent, and contains a whole chapter entitled, "The Role of Medication in Treating PTSD".

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You'll also want to learn as much as you can -- though this is primarily your healthcare provider's reponsibility, yet it's in your best interests to care about this as well -- about possible interactions, if you're taking a number of medications; as well as thinking through carefully whether the risks involved are ones you want to agree to, such as the potential that a medication -- bizarrely enough, prescribed for PTSD or depression -- may actually increase risk of suicide. (An example of news coverage about this is linked, here.)  Strange, and perhaps unavoidable, but true.

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Use caution whenever evaluating information about medications, especially as a non-professional, but at the same time, don't "just" believe what a healthcare provider tells you: be sure to check it out for yourself or your family member, at reputable sites like the ones mentioned above.  Your health is in your hands, so while you want and should actively solicit the expert advice of healthcare providers familiar with PTSD -- and don't settle for less :-), at the same time, YOU are the one who's going to be bearing the brunt of anything that goes wrong, so be sure to do your own due diligence and figure out what the possible side-effects, interactions, and unpleasant experiences might be for you, before you commit to a course of treatment.  You and your healthcare provider can be partners -- that's the new model -- not just "master" and "servant," or "priest" and "parishioner."  Take an active, informed role in your own healthcare, particularly where medications are concerned. 

Living in the Prison of PTSD - a Poem by a Vietnam Vet and Suicide

I received a photo of this poem, by a Vietnam veteran who committed suicide shortly after he wrote it, in the manuscript of another Vietnam veteran's memoirs from his time as a Marine in Vietnam, and after homecoming.  This poem is apparently up on the wall of the "Post Traumatic Stress Unit" at the Veterans Affairs Medical Center in Waco, Texas.

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(It's easy to understand honoring the vet who wrote this poem as one of his last pleas, but seriously -- if I were being treated for PTSD and were struggling with some of the same issues, I'm not sure it would be that perky to go by this particular wall art regularly and remind myself, oh yeah, right after that guy wrote that -- well, he ended things.  Even though it's perfectly understandable why he felt things had gotten to that point; and equally well how the other vets and the staff there would want to honor his passing with this tribute.  People who believe in the ancient Chinese art of placement, feng shui, would say, never hang anything on the wall that brings your energy down, not up, when you look at it.  But I'm sure they did it out of love and respect for the guy concerned...)

As for the poem -- well, it's not gonna win any awards as a poem, but in terms of conveying one man's brokenness and pathos, it does that really well. Very sorry the story had to have such a sad ending, and not just for this veteran, but for many others like him, from Vietnam and other wars.  Here's what the poet, known only to us by his initials, "A.W.D.," wrote in 1989:

Solitude

I have lived in this prison I built for most

        of my life

And I have blocked out all reason, all guilt

        and all strife.

No one may enter this prison of mine

For I have failed at life,

        now I resign.

Now as I sit here too cloudy to think

My mind and body, they no longer link

My life I see before me, like old movies that

        aren’t real

But that’s what I see and

        that’s what I feel.

May God have mercy, may He not be cruel

May He understand the prayer of a fool

Inside of me, I hear the screams of distress

Let me out of this prison

        Please let me rest.

-- A.W.D., 1989

The Suicide Profile: Clinically Known Risk Factors for Potential Suicides

I've got an old psychiatry textbook for medical students, written by a professor at Harvard Medical School named Robert J. Waldinger, M.D., and it's been interesting leafing through it and finding out what it has to say about PTSD (not much) and suicide (quite a lot).  The edition I have is the second edition (a third edition is in print), and it goes back almost 20 years, to 1990.  PTSD is covered in less than a page, but suicide has quite a bit of coverage, and much of what it says is interesting.

For example:

"A majority (60-80%) of people who commit suicide carry a diagnosis of depression.  Estimates of the risk of suicide in all mood disorders are as high as 15%, with the greatest period of risk within 5 years after the onset of the disorder.  The risk of suicide among people with mood disorders is 30 times that of the general population."

There's also this longer passage about who's most at risk for suicide.  The passage was written based on data that was available at the time -- 1990 -- and some of the percentages have changed up or down since then. However, as you read these factors, think about how many of them might be in play for combat veterans, in light of the recent rise in veteran suicides. Our observation?  Quite a few. See if you don't agree:

"Suicidologists have long searched for "suicide profiles." They have looked at everything from the phases of the moon to birth order in the family in an effort to solve the mystery of why certain people resort to suicide. The following are the risk factors most consistently identified in recent studies:

• Age- The risk of suicide ... is greatest for nonwhite males in their 20s and 30s, and rises again (in the elderly).  Nonwhite females have the highest suicide rate in young adulthood to age 40, with a decline thereafter.  In the last 25 years there has been a more than three-fold increase in the rate of suicide among adolescents and young adults (and this figure has only gone up);
• Sex - Men commit suicide three times more frequently than women.  However, women attempt suicide two to three times as often as men.  Men tend to use knives, firearms and other violent means of suicide, while women show a preference for self-poisoning;
• Race - The suicide rate is higher for whites than nonwhites. However the rate among young black adults in ghetto areas has recently increased sharply;
• Marital status - Suicide rates are lowest for married people and higher for those who are separated, divorced, or widowed;
• Living situation - People who live alone are at a higher risk of suicide than people who live with others;
• Employment status - People who are unemployed are at a higher risk of suicide than those who are working in or out of the home ...;
• Physical health - Physical illness, or the perception that one is ill, is more frequent among those who commit suicide.  In particular, there is a high correlation between completed suicide and visits to a physician for medical complaints during the preceding six (6) months.  The risk of suicide is significantly increased among people suffering from cancer and AIDS;
• Mental health- Among the mental illnesses that have been correlated with a high risk of suicide are depression, manic-depressive illness (bipolar disorder), and schizophrenia.  Non-fatal attempts are more prevalent among people with personality disorders, and adjustment disorders.  In general, the presence of major mental illness should alert the clinician to the possibility of suicide.  More than 90% of adults who commit suicide have an associated psychiatric illness;
• Alcohol abuse or addiction - Alcoholism markedly increases the risk of suicide;
• Previous suicide attempts - A history of suicide attempts has been estimated to increase the risk of completed suicide by as much as 64 times that of the general population.  At least 10% of suicide attempters eventually kill themselves;

The following factors, while less easily quantifiable, have also been associated with completed suicides:

• Hopelessness - Several studies have concluded that the specific symptom of hopelessness about one's life situation is more highly correlated with suicide than is the more general category of depression;
• Interpersonal loss- There is a high correlation between interpersonal loss and suicide.  Loss is defined as the separation from, divorce from, or death of a significant other, and may include relatives, friends, lovers, and therapists.  The risk of suicide is particularly high among alcoholic individuals who have suffered major interpersonal losses within the previous six (6) weeks;
• Life stresses - A high frequency of major life events in the previous six (6) months has been found among those who commit suicide.  Such events include job changes, moves, births, graduations, financial reversals, marriage, retirement and menopause.  Such changes are important to identify in assessing both the precipitants of a suicidal crises and the possibilities for therapeutic intervention;
• Interpersonal conflict - Long-standing intense interpersonal conflict with family members or other important people is associated with a high risk of suicide and has led some observers to characterize suicide as a fundamentally dyadic [definition] event.  Such conflict, if unremitting, may continue to jeopardize the life of the patient after a particular crisis has passed. "

Source: Psychiatry for Medical Students, Second Edition, by Robert J. Waldinger, M.D.  (Instructor in Psychiatry, Harvard Medical School, Director of Training, Massachusetts Mental Health Center, Boston, Massachusetts.)  Washington, DC: American Psychiatric Press, Inc.  (1990).

What the VA Needs Is "The Odwalla Effect"

[If this blog were a newspaper, which it isn't, this particular blog post would be an editorial -- found in the opinion section, separate from the rest of the paper.  The editorial section is where the editor "puts together" what the news means to him or her, and sets out a point of view, about what we should do or feel, think or believe about something, based on what else has been in the news lately, that they've been keeping people up to speed on.  It's the opinion section, essentially -- but from the editorial management's point of view.]

Here's ours:

Kathie Costos has a great series of posts over at her blog, linked here, but there's one in particular we'd like to talk about - and we'll leave you the link to it in a minute, so you can read it for yourself.  First, the discussion.  Kathie is conducting a question and answer session with Paul Sullivan, head of Veterans for Common Sense, clearing up "rumors" about the veterans' lawsuit against the VA.  Sullivan's answers are clear and to the point, and contain some fairly galvanizing statements, pro or con.

[I should insert the caveat here, in an effort to be balanced, that I DON'T believe the VA is "all bad," nor do I imagine Costos or Sullivan does.  Every once in a while you DO read about people who are extremely thankful and grateful for the care they're received through the VA - I read an item the other day where a veteran was reminding us that they have one of the best healthcare systems in the world.  True.  But that also brings up a question of which metric you're using, since while they are succeeding in some areas, they are clearly failing in others (and those are the areas which are making the news, frustrating veterans and families, and where they're being sued.)  Highly competent, concerned and caring individuals DO work for the VA -- many of the leading lights of care in the PTSD segment in particular have come from, or worked with, or still do work with, the VA.  People who are tremendously significant in the history of caring for veterans in an extremely high quality, enlightened, empathic way -- so people like that DO work for the VA, and always have.  Look through the "Experts" section on this blog, and see how many people have an affiliation with the VA, past or present: Ray Scurfield, Shad Meshad, Jonathan Shay, as well as others, all come to mind. (For the record, these people were probably "born" (wonderful) not "made" (wonderful) by their association with the VA as caregivers, but still -- they worked there and in some cases, still do.  And God knows, the VA heavily reads this website -- even at odd hours -- including very late at night, on weekends, on national holidays -- times when the rest of America is out grilling a hotdog with their family, throwing a ball in a park, or just snoozing the night away -- so clearly there are some very dedicated individuals there, trying to learn all they can in order to deliver better care to those who are suffering.  (Though they may also be reading to keep up with public opinion, to see which way the wind blows...)

I do sometimes wonder when I see what the VA is searching for, on this site, because it either seems kinda elementary (like they should know about it already), or a little "weak" in the efficacy of treatment department (like things that are waaaaaaaaaaay down the totem pole or triage pile of things to actually try with a demographic of patients who are suffering greatly). To give you an idea of what I'm talking about, frequent searches -- and the topics change regularly -- by the VA include such things as "spirituality for PTSD," "does recreation help?" and things like that, where, really, yes, even if they do -- they're only adjuncts and pretty far down the list at that, compared to more likely things that seem worth trying or are known to have some benefit.  But maybe I should just be patient, and it's more a case of "if you build it, they will come."  Maybe there's a huge lag time afoot, where if the information is laid out there, eventually the searches will catch up -- on the VA's part, that is.]

(Huge digression -- but the point is, the VA's not all bad, and that's NOT the point of suggesting they change, which it certainly seems like they should.)

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Deep in the Q&A between Costos and Sullivan is this exchange, with the comment of importance highlighted:

Do you know about the Freedom of Information request to the VA by CREW and VoteVets?(Which we blogged about earlier here, by the way.)

Yes. It is too bad that VA still plays games with FOIA. VA should be forced to turn over the information. Embarrassing information is never a reason to deny a FOIA, as VA frequently does.

Alrighty now.  That was the warmup (the foregoing).  Here's the pitch:

If the VA wants to control the flow of embarrassing information about it -- such as the Katz and Perez emails have provided us with -- there's one extremely simple way to do it.  It's NOT hiring a PR firm that specializes in crisis management and controlling the spin.  That's morally and ethically disgusting -- when contrasted with the concept of just changing -- and, it's ridiculously expensive -- a true waste of money that could be better spent on taking care of veterans and their families, with the needs the VA already knows about. And by promoting good works, like those of combat veteran Jay White, at the VA Center in Hartford, Connecticut, which we blogged about here.  Those ALSO make the news and contribute to public opinion, though everyone knows, and it's unfortunate that it's true, bad news travels first.  (And bad news here is definitely the Katz and the Perez emails, and the lack of putting patients first they describe, not to mention the rash of veterans suicides, etc.) Denying patients adequate care?  There's just no way to put a positive enough spin on that.  And the extent of the media coverage has been such, yup, we pretty much all know about it by now, if we even remotely care to.  Game over.  What needs to happen next is what happened with the Odwalla juice company -- what the VA desperately needs is the Odwalla effect.

Years ago, Odwalla was a new company with a great product: fresh juice, delivered nationally.  I knew someone whose three college friends had started it, and because of that, I guess I paid attention to what it was, and when I had the chance, tried the juice.  It was great, and for a while, everybody I saw who wasn't carrying some bottled water, seemed to be carrying a container of their juice.  They had, and still have, a number of blended juices, as well as the straight-up orange and apple.  And they had a novel, and in hindsight quite unwise, approach.  Their juice was unpasteurized, which they felt was needed to keep the juice as fresh-tasting and delicious as possible, but which also carried some known health risks, because pasteurization kills bacteria.  Children (particularly babies) and the elderly, as well as a few other groups (those recovering from illness and surgery, etc.) have weaker immunities -- in other words, are more susceptible to bacteria.  And I don't remember that Odwalla plastered their juice labels with big warnings about: "Warning! Our lack of pasteurization makes this juice likely unsafe for children and the elderly!".  They probably just made their juice, concentrated on getting it to market, and hoped people toasted each other with its deliciousness.  But over time, the inevitable happened: a few people who tasted their fresh, delicious (and unpasteurized) juices got sick - and, horribly - died.  And some of the affected were children, which the American public finds of course especially heartbreaking, and worthy of media attention.

In an instant, it seemed -- everyone turned on Odwalla, the juice and the company.  It went from being a media darling, to an object of abhorrence and fear.  How could they have let their juice kill people -- young children, even?  Horrifying...  Based on the immediate and complete backlash in the press and public opinion, I easily imagined Odwalla going under, and my friend's three college friends being put of work, and skulking away in public disgrace.

What happened next was amazing, though: and it shows you the power of good, and of doing the right thing.  (There's a conflicting story on the Web, but if you read the date on it, it's from 1999, which is ridiculously old news -- before the Odwalla success story of managing its PR happened, and before the company was later sold to Coca Cola - another evidence of its success. Plus, the guy who wrote it is by no means is a PR specialist, nor does he even seem to understand how PR works. I did work in PR, though I'm no expert on crisis management - I do get how it works.)  Odwalla didn't go bankrupt, didn't go out of business, didn't leave the marketplace in shame and disgrace.  What DID they do?  Simple as could be, and oh so powerful:

They accepted responsibility.  They apologized and paid the families' bills.  And they changed their process, so more people wouldn't be hurt by it.  They were wrong; they admitted it; they did what it took to make it right; and they changed.

In other words -- EXACTLY what the VA needs to do.

By now, we all know what the problems are, if we've cared at all to listen and learn.  They're kinda obvious.  And no amount of re-spinning the truth is going to make the problem go away.  All the media attention and lawsuit has done is show us the gaps in the system, the problems with care.  And because most caring, compassionate, fair-minded Americans care MORE about their veterans - we "get" the price they've paid -- than we do about hearing excuses and spin -- there's only one real solution here.  Admit the problem(s), apologize to those you've affected (veterans, their families, and the rest of us, who while less directly involved, are nevertheless put off by what we've learned), and fix the process.  Let tomorrow be vastly different from today, because you're starting to work -- really work -- on the problem, now.  The problem that we -- you, me, veterans, their families, the media, Veterans for Common Sense, the IAVA, the Disability Rights Project, Paul Sullivan, Kathie Costos -- all know exists.

Lack of pasteurization, denying veterans care -- and, if you'll allow me -- O.J. Simpson have all have been linked to killing people.  But in a contest between two kinds of OJ -- Odwalla and Simpson -- please, VA, we beg of you: show yourselves to be more like Odwalla, and less like Simpson. Fess up, come clean, do what's right by veterans and their families, make it right.  Now more than ever, what the VA seriously needs to re-create good public opinion is not denial, spin and blocking legitimate FOIA requests, in case something embarrassing gets revealed -- it's a simple thing called "the Odwalla Effect."  Also known as, doing the right thing, for the right reason, makes public opinion bounce right back.

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Editor's note: Kathie Costos' Q&A with Paul Sullivan of Veterans for Common Sense about the veterans' lawsuit is linked here. Kathie Costos' blog, "Wounded Times," is linked here. Veterans for Common Sense is linked here.

Making an Attempt to "Strip the Fuse" - Initiating Dialogue between Local Police and Veterans

NPR has another great story today, on a few OIF/OEF (Iraq and Afghanistan) combat veterans telling their stories in a public setting, in an attempt to defuse potential conflict with the communities where they live, especially with the police.  The story is called, "Dialogue Bridges Divide between Vets and Police," reported by Libby Lewis, and you can read the story or listen to it, here. It highlights the work being done by Jay White of the Hartford, Connecticut Vet Center, a facility funded by the Department of Veterans Affairs. According to Lewis, "before becoming a counselor, White served two tours in Iraq. The dialogues he moderates are meant to connect veterans with people who have no experience with war, namely people who deal with trouble — like police and emergency rescue personnel. These are the people whom soldiers returning home often find themselves dealing with."  It's great to see necessary, proactive stuff like this.

A surprising statistic, quoted in the story, by Brian Killany, a police crisis negotiator:

"The chances of [veterans] becoming a target group for us to have to deal with as a [police] negotiator is probably better than 50-50.”

Y-I-K-E-S.  Forewarned is forearmed -- no pun intended.  So much better to prepare for this in the way this program is doing, than be surprised by it -- when it's clearly a strong possibililty.

The NPR story also highlights the work of a Connecticut-based group, "Brothers in Arms," which the program says is "run by Iraq veterans with a mission of helping other returning soldiers. They also organize public speaking events to create awareness among civilians about the struggles of war veterans."  Their information is linked here.

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In addition, although not mentioned in the story, there's a great, 10 minute long video available on YouTube, which we blogged about here, by William R. Keating and the Norfolk County (Massachusetts) District Attorney's Office.  It's called "PTSD and Veterans: Beyond the Yellow Ribbon," and part of what it addresses is the re-integration of a combat veteran into his or her community, including the possibility of conflict with the police, and how both sides can manage that.  Well worth watching and bookmarking. The blog post we did about it a year or so ago is linked here, and it includes the video.

(Other counties in Massachusetts and in other states should consider contact William Keating's office and seeing if they can use the video with their constituents.  Information useful for contacting the Norfolk County (Massachusetts) District Attorney's office is linked, here.)

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Recently, we blogged about the similarities that cops and troops share in their exposure to cumulative increments of trauma, which often result -- for either of them -- in PTSD.  Ultimately, cops and troops may find out that they may find out they have more in common than they thought -- in terms of what they've been exposed to in their lines of work -- not just wearing uniforms, working out and carrying guns to work. 

Editor's note: The Hartford, Connecticut Vet Center information is linked here.  The directory lists Jay White but provides no additional contact information for him; undoubtedly, he can be reached the Center.

NPR Local Affiliate KQED's Story about VA Being Sued over Veterans' Healthcare

According to a story aired today on KQED -- a San Francisco public radio and television station, and NPR affiliate -- Berkeley, California's Disability Rights Advocates recently filed a lawsuit "that could affect thousands of veterans returning from Iraq and Afghanistan. They allege that the Department of Veterans Affairs is unable to provide timely mental health treatment for returning veterans. It describes a backlog of 600,000 claims for vets seeking care — some dating all the way back to the Vietnam War." To listen to the approximately five minute story, click here.  (And yes, this is the lawsuit that's produced the incendiary emails that have lately been in the news, including the infamous "shhh..." one about veterans suicides, which we blogged about earlier, here.)

Editor's Note: For more information about the veterans access to healthcare lawsuit in Federal court, as provided by the Disability Rights Advocates website, click here.

Rob Honzell's First Person Account, as a Vietnam Vet, of Combat PTSD

An update on an earlier blog post, from February of this year.  Rob Honzell, Sr., M.S.'s book, First Person: Combat PTSD, is now available at Amazon.com.  It's Honzell's account, in his own words, of what his Vietnam experience was like, and how they've affected the ensuing years since.  Not sure how much of it relates specifically to PTSD, despite the title -- I've just started leafing through it -- but to the extent that it's written by a Vietnam veteran who's been coming to terms with what he experienced ever since, it's worth knowing it's out there, and maybe seeing if your local library will buy a copy, to keep the Vietnam experience alive so we can keep learning from it.

It's also fair to say, not many people are able to write about their own experiences with PTSD - it's just too devastating.  We mentioned the other day a book that's just come out by an Army Ranger, Nate Self, about his Two Wars: with insurgents and with his own PTSD -- from the current OIF/OEF conflict.  With hundreds of books about the wars in our collective lifetimes, the just aren't many that address this topic directly, by people who've experienced PTSD.  Let's hope these are the start of many more contributions to the first person narrative literature on the subject.

Healing Hands: Cranio-Sacral Therapy, Veterans and PTSD

Before we leave off talking about Complementary and Alternative Medicine (CAM) therapeutic strategies for dealing with PTSD (usually, in addition to other approaches, not instead of other approaches) -- as we have been discussing lately on this blog, an index to which is linked, here -- it's important to mention one other therapeutic technique: Cranio-Sacral Therapy, developed by Dr. John Upledger (pictured at left).  You'll have to go elswhere -- like the Upledger Institute's website, linked here -- to learn more about the practice -- it would take too long to explain here, because there are several schools of thought on why it might work, and it's a fairly esoteric practice to begin with.  But...an important but...it is a bodywork therapy, akin to massage but not the same as massage, which has shown some effectiveness in improving the symptoms of PTSD.   Digging around on the Upledger Institute's site may help you learn about who practices it in your area of the country, but that is unlikely to be a completely comprehensive list.

For those who believe -- and it surely isn't everyone who does, but many do -- that the physical body "stores" trauma, craniosacral therapy attempts to "release" the stored trauma through the very light, deft touch of the craniosacral therapist.  Not everyone who's been through trauma wants to "talk about it," or "take medications for it" -- for those who are comfortable with a massage-like experience, craniosacral therapy is an opportunity to see if trauma can be cleared, lightly or substantially, using a different method.  (Rumor has it that the Navy and/or the Marine Corps, on the West Coast, is experimenting with using craniosacral therapy to treat PTSD -- more news as that develops.)

Dr. Upledger, and another West Palm Beach, FL-area craniosacral therapist, who I have known for years, and who used to practice together, worked in a novel program years ago to treat Vietnam veterans who were struggling with the effects of PTSD.  In their program were a handful of veterans and at least one medical nurse who had served during Vietnam.  The treatment program allegedly helped some, didn't help some others, and had at least one anomaly as a result: a patient who died in an unrelated car accident, soon after he reported to his family, unfortunately, how much relief he was gaining from the program.  So the results were mixed, but in general, more positive than negative.  (There was even some interest from a famous Hollywood filmmaker, who shall remain anonymous, but who's a big fan of veterans and the Vietnam experience, in filming the experience of veterans undergoing the treatments, but that created controversy for the program, and the idea was eventually dropped.)

Years later, Dr. Upledger did more work with other veterans, and at least one of them, Steve Shumelda, LMT, an ex-military guy with injuries of his own, including PTSD -- was so impressed by the treatments that he gave up whatever he was doing for a living before, and studied craniosacral therapy instead.  He has a practice in South Florida now, and has written about his experience with craniosacral therapy.  You can read more about the Upledger Institute's work with veterans and PTSD, here.

Dr. Upledger has apparently done a video that is available via his Institute on PTSD and veterans and craniosacral therapy.  You can contact their office to see about purchasing a copy.  For additional resources to read up on the topic of craniosacral therapy, veterans and PTSD, click here for a separate blog entry we did recently that consolidates a few in one place.  To read about Vietnam veteran and former Navy corpsman Steve Shumelda, LMT's experience with PTSD and craniosacral therapy, click here.

CranioSacral Therapy, PTSD and Veterans Resources

(This is a drawing by a young child who had PTSD but clearly was not a veteran, given to his CranioSacral practitioner, illustrating what he felt to be her "healing hands.") 

Some resources about CranioSacral therapy and PTSD (this list is not meant to be exhaustive):

An article written by Dr. John Upledger, founder of CranioSacral Therapy, published in the November, 2001 issue of Massage Today magazine, on "The Role of CranioSacral Therapy in Addressing Post-Traumatic Stress," linked here;

An article from the January, 2001 issue of Massage Today magazine, written by the magazine's editorial staff, called "The Power of Touch: Promising Studies on Treatment of Post-Traumatic Stress Disorder," linked here;

An article from the Internationa Alliance of Healthcare Educators (IAHE) newsletter, date unknown but possibly current/2008, written by the Upledger Institute, called "Upledger Research Effective for Vietnam Vets," linked here;

An article from the Upledger Institute's newsletter, apparently from 2007, entitled "CranioSacral Therapy Breaks 20 Year Cycle of PTSD," linked here.  That's the article that talks about Vietnam veteran and former Navy corpsman Steve Shumelda, LMT's experience with PTSD and craniosacral therapy, which predated his career path change.  That article is linked here.

Mind Body Medicine: Healing the Wounds of War

When I started this blog over two years ago now, I was hoping that somehow James S. Gordon, M.D., and the Center for Mind-Body Medicine which he founded in Washington, DC, would somehow get involved in the prospect of bringing mind-body medicine to the troops.  Gordon is a Harvard-trained psychiatrist, with impeccable credentials, who has a lifetime interest in expanding patient care into new areas, particularly Complementary and Alternative Medicine (CAM), and mind-body medicine in particular.  (Mind-body medicine is a shorthand way of re-combining the two "halves" of medicine perhaps unjustly sundered in an arbitrary Cartesian mind-body split.  Much of Eastern thought, rather than Western, never saw them divided at all.)  In a previous lifetime, where I interviewed luminaries in the natural medicine field, Gordon was a favorite interviewee - smart, genial and with a very forward-thinking grasp of what mind-body medicine could accomplish.  Gordon, who was featured in the Bill Moyers series on PBS, Healing and the Mind, was a frequent lecturer at the Smithsonian Institution in Washington, DC, and for years had served as the head of the White House Commission on Complementary and Alternative Medicine.  He is also a Clinical Professor in the Departments of Psychiatry and Family Medicine at Georgetown University Medical School.

But more to our purposes, when war broke out in Kosovo, he and the Center for Mind-Body Medicine (CMBM) took their methods into the region, creating a program called "Healing the Wounds of War," to help war-torn schoolchildren and their caregivers manage the trauma they had undergone, through a sustained, devastating conflict.  What I was hoping -- and I kept checking the CMBM website periodically to find out -- was that they would leapfrog off their successes with PTSD in Bosnia and Kosovo, and Israel and the Middle East, and develop something geared to PTSD in servicemembers, and the conflicts in Afghanistan and Iraq.  For years, nothing was obvious (yet), but here's some of their success with children in Kosovo.  Notice what symptoms the program helped with, how impressive the statistics are, and make the conceptual leap to how this might help with combat veterans and/or their families:

The clinical efficacy of the CMBM program with traumatized children has been repeatedly demonstrated. In a pilot study in which high school teachers in the Suhareka region of Kosovo used the CMBM model, levels of posttraumatic stress disorder in high school students were reduced from an average of 88% to 38% in only six weeks (read the research, published in Journal of Traumatic Stress, April 2004, linked here). Participants have also reported the following documented effects of CMBM trainings, including: the alleviation of their own stress and trauma; decreases in anxiety and depression; increased optimism; decreased anger; and increased capacity to help others.

You can read more about the program's specific successes, here.  Or, you can read a general overview of the program and what's involved, here.  You can also read Dr. Gordon's bio, here.

Mind Body Medicine: Healing the Troops

We've talked about James S. Gordon, M.D.'s Center for Mind-Body Medicine and their successes in "Healing the Wounds of War" recently on this blog, and the wait to see if they would revamp this program to address the needs of PTSD and the troops.  Finally, at long last...The Center for Mind-Body Medicine's program for Healing the Troops, informational material linked here.

From their website:

The Center has created a program of training in mind-body medicine and on-going support for physicians and mental health professionals working with veterans returning from Iraq and Afghanistan as a first step to providing veterans with a powerful and healthy approach to dealing with the stress of war and to enhancing their resiliency.

This program will be a significant focus at our Fall 2008 Mind-Body Medicine training, for which we have received funding to bring 20 military healthcare professionals on scholarship. We are seeking additional funding for this important effort.

Also from their website:

The Center for Mind-Body Medicine has developed a trauma relief program utilizing mind-body skills including biofeedback, relaxation, guided imagery, meditation, drawing, and breathing exercises that has been used successfully around the world.

This program, which is presented in small educational groups, has the advantage of enhancing veterans’ capacity to help themselves while mobilizing social support crucial to full recovery. The Center has used this program to assist in population-wide healing efforts in war-torn and traumatized regions around the world, including Bosnia, Kosovo, Macedonia, Israel and Gaza , and in the United States with NYC firefighters post-9/11 and in post-Katrina Louisiana.

Further information about the 2008 conference is linked here. Dr. Gordon's bio is linked here.

PTSD Trauma for Veterans and Their Families is Predictable - "The Generic Effects of Combat"

In an article from Australia, there's a great quote about combat trauma/PTSD, and its very ordinariness.

(The article's topic is how "mental health problems caused by war service afflict veterans' families and children too.)  One of the premises of the article is that, based on a study, "Sons and daughters of Vietnam veterans are three times more likely to commit suicide than those of similar age in the general population (Australian Institute of Health and Welfare 2000, Suicide in Vietnam veterans' children: Supplementary report no.1).  According to the same report, "They are also more likely to die of accidental death, experience depression and abuse alcohol or other drugs."

That's the overall pretext for the article.  However, now comes the excellent quote, with a bit of preamble from the article itself, linked here:

According to Professor Hedley Peach, conducting research into veterans' sons and daughters is vital, not only to examine in detail the reasons behind their poor health but to set up support services that work for them.  He is also eager for doctors to consider war service when treating patients, as in many cases it could help diagnosis ....  Peach, a member of the scientific committee advising the Government on the feasibility study and professorial fellow at the University of Melbourne, says the Government should also consider studying grandchildren of Vietnam veterans to avoid more problems spiralling down through the generations.

''If the sons and daughters have got mental health problems and have young children themselves, what effect will that have on the grandchildren? We have to break the cycle.''

He suggests stressful familial environments could be behind the children's mental health problems, already highlighted by existing research. While many people with mental illness have a genetic predisposition to their condition, veterans were screened for mental illness before they went into the service, making stress a more likely factor in the children's ill health.

''In studies done by clinical psychologists running PTSD clinics for Vietnam veterans, children have reported a high level of dysfunction in families,'' he says. ''When we focused on Agent Orange so much in the past we missed the bigger picture. We are seeing the same sorts of problems in veterans of the Iraq and Gulf Wars, and fighters in World War II are now saying they suffered from the same problems. It is not due to any specific war, it is the generic effect of combat.''

Thanks to Kathie Costos for this reference...

Chaplain John Morris, Minnesota National Guard

Caveat gentle reader: We have no idea if Chaplain John Morris, oft-quoted chaplain of the Minnesota National Guard, is any sort of functional expert on PTSD.  What we do know is he's a straight-talking, reasonable proponent of caring for the troops, and as such, he totally has our vote of confidence.  Here's a little biographical information about him:

John Morris, an Army Reservist, has served in Norway; Kuwait; Qatar; Iraq; Cuba; Ft. Steward, Georgia; Ft. Benning, Georgia; Ft. McCoy, Wisconsin; Ft. Bragg, North Carolina; and Ft. Irwin, California. After serving as senior pastor at St. Croix Valley United Methodist Church for eight years, he was mobilized to serve with Army Special Operations Command in January 2004. In Iraq, he visited Psychological Operations teams in 17 different camps. Chaplain Major Morris is currently a full-time chaplain with the Minnesota National Guard. He is a 1986 graduate of Minnesota's Bethel Seminary.

He's frequently quoted by NPR, the Cloquet, Minn. Pine Journal, which did a fine series of articles on Minnesota's returning National Guard veterans, and the Christian Science Monitor.  We've blogged about hm in a series of posts, linked here.  He's immensely quotable, and he's a heartsy proponent of meeting the troops head on with the type of care they need, and he seems to have that rarest of all professional qualities -- a serious clue.  I'm a huge fan...

(References to Chaplain John Morris of the Minnesota National Guard on this blog are here, here, here, and possibly here, not to mention, most recently, here.)  In his wonderful essay, linked here, you can read his thoughts on "Beyond the Yellow Ribbon: How Churches Can Help Soldiers and Their Families Readjust after Combat."  (A podcast by Chaplain Morris is linked on another blog, here.)

Another Great Bibliography on PTSD

It's no secret that "we heart librarians" -- they're amazing in their ability to consolidate worthwhile, previously-vetted resources like none other.  Here's an excellent bibliography of PTSD resources that's already on the Web, compiled more than 10 years ago now (so it needs updating, but don't quibble -- it's plenty good for what it is) by Lisa S. Beall, behavioral sciences librarian at Auburn University, linked here.  Enjoy.  It joins Lisa Sedakel's, blogged about earlier, here, as another one worth reading and keeping on file for future reference. (Another good academic bibliography is found within Mary Elizabeth Claire, Ph.D.'s thesis on police and PTSD, from Drexel University, which we blogged about here.)

Floyd "Shad" Meshad, MSW

After earning his Masters degree in Psychiatric Social Work from Florida State University in 1968, Shad went on active duty in 1969 as a Captain in the U.S. Army. In 1970, he served one tour as a Social Work/Psychology Officer for I and II Corps in the Republic of South Vietnam.

Upon his return to the states, Meshad continued his dedication to American veterans by starting the Vietnam Veterans Re-Socialization Unit at the Brentwood, CA VA Hospital in 1971. He spent eight years working with Vietnam veterans and their severe readjustment problems in the Los Angeles area. Shad was one of the pioneers in the study of the disorder known as Post-Traumatic Stress Disorder, or PTSD.

In the past 27 years, Shad has received many service awards and recognitions for his work. He authored a book about his year in Vietnam, Captain for Dark Mornings, which, highly acclaimed, is in its second printing. Meshad has made appearances on many major television networks and cable news talk shows, including 60 Minutes, 20/20, Dateline, Nightline, and CNN News. Shad continues to consult, train, and counsel nationally and internationally.

In 1986, Shad started a stress management and consulting service. In the early 90's he began focusing on treating compassion fatigue. This condition is identical to secondary traumatic stress disorder (STSD) and is the equivalent of PTSD. It is the stress resulting from helping or wanting to help a traumatized person. Through his associations, Shad introduced Charles Figley, Ph.D., a long-time friend and colleague to Dr. Roger Callahan who developed Thought Field Therapy. Dr. Callahan approached Meshad with the opportunity to study the effect of TFT therapy on veterans who suffered from PTSD. Impressed by the amazing results of this study, Shad has become a certified TFT diagnostician and practitioner, offering seminars on Levels I and II TFT nationwide.

In 2000 Shad founded Quantum Performance Institute with the goal of utilizing the amazing power of energy psychology techniques in the area of negative emotional states and attaining one's optimum performance level.

(More information follows, from a separate bio)

For more than 30 years, National Veterans Foundation (NVF) Founder and President Shad Meshad has worked as a therapist for veterans and an advocate for veterans’ rights. After receiving his master’s degree in psychiatric social work from Florida State University, he enlisted in the army in 1970, and served as a counselor for U.S. soldiers in Vietnam.

Upon his return to the U.S., Meshad founded and directed the Vietnam Veterans Re-Socialization Unit at the VA Hospital in Los Angeles, California. It was the first program of its kind, focusing on the readjustment problems of Vietnam veterans. During this time, Meshad was among the first to study the disorder now known as Post-Traumatic Stress Disorder, or PTSD.

In 1978, he worked to develop and lobby for the National Vietnam Veterans Readjustment Bill. In 1979, he founded the Vet Center Outreach Program, which now serves veterans in more than 200 locations across the country.

In 1980, Meshad was nominated for the first Olin Teague Medal of Service Award. In 1982, he published a memoir of his experiences in Vietnam, entitled “Captain for Dark Mornings.” In 1985, he founded the Vietnam Veterans Aid Foundation, which he later renamed the National Veterans Foundation.

He has served on the faculty of the International Critical Incident Foundation; as President and Board Member of the Association of Traumatic Stress Specialists; and, recently, was appointed to the Board of Directors of the Green Cross Project.

In the wake of the catastrophic events of September 11, 2001, Meshad was called upon by the U.S. government to help train the critical incident and trauma teams at Ground Zero.

Today, Meshad consults and teaches stress reduction and anger management techniques to mental health, law enforcement, and critical incident professionals through Quantum Performance Institute, a firm he established in 2001. He continues his work with veterans in the Los Angeles area, helping them through the process of healing and readjustment.

One Great Book: "Home to War - A History of the Vietnam Veterans Movement," by Gerald Nicosia

"The Past Does Not Equal the Future" -- queue Tony Robbins -- well, unless we refuse to learn the copious lessons of the past, in which case it very well might -- or it might make the past look positively enlightened, by comparison.  Another take on the same thing, by the perennial, inveterate quotemeister himself, Ben Franklin: "Experience keeps a dear [expensive] school, but fools will learn in no other."  I'm reading the greatest book right now, recommended by another journalist who's interested in veterans issues -- "Home to War: A History of the Vietnam Veterans Movement," by Gerald Nicosia, linked here.  It's 2 lbs., 10 oz., 689 pages, and roughly 136 cubic inches of nowhere-else-to-be-found material on the actual history of what created the Vietnam veterans' movement, which informs the veterans' rights movement of today, including the efforts to destigmatize PTSD, figure out what it was, re-include it in the DSM manual for psychiatrists (where it had been removed), etc.  Just fascinating.  All the players are there -- dozens of politically important types, including John Kerry, Ron Kovic (if you've seen "Born on the Fourth of July," you know who he is) as well as therapeutically important ones -- Shad Meshad, Ray Scurfield, Arthur Blank, M.D., Sarah Haley, etc. 

As a late-model Child of the Sixties, I had completely forgotten how much sheer effort -- blood, sweat and tears -- it took to get certain things passed that we now take for granted: better care at the VA, better provisions in the GI Bill, etc.  I had totally forgotten about the armed protests, the hunger strikes and sit-ins at the VA, etc.  It made me wonder whether leaders of the current veteran rights movements actually KNOW this history, and know how far their predecessors had to go, to secure the rights veterans rely on today -- which still need to keep pace with the times, and haven't.  The book is just plain fascinating, and b/c it's relatively neutrally written (as opposed to written with partisanship), with a steadfast focus on the facts and the key participants -- and because it's based on 600 or so interviews with the actual players, it's both extremely well done (a PBS series in book form, but with more depth!) and should keep my interest for quite a while.  So fascinating to know, or begin to hazily recall, the all-important "backstory" of where we are today.  And the insights on the genesis of understanding PTSD are well worth revisiting, all on their own.  Great book - wish I'd known about it before. As more and more veterans send me (unsolicited, I might add) their life stories, or their experiences with PTSD, I have to say -- this book really puts an awful lot together, behind the scenes, as to why they suffered in silence for so long.  Wonderful effort, and a pleasure to read.

Too bad tomorrow is already "Father's Day," but if you're lacking a gift for a veteran dad, Vietnam era or later, and can find this in stock at a local bookstore, it's a superlative collection of everything that went before, and helps us to understand the issues of the present, through the highly informing prism of the past.

Patriot Hills: A Recreation and Wellness Center for Wounded Warriors Planned for Upstate New York

The Albany Times-Union has an article in Friday's paper, linked here, called "A Bridge from Wartime to Civilian Life: Fundraising begins for Patriot Hills, a planned wellness center for National Guard soldiers."  According to the article, Jeannine Mannarino, 48, a retired Army National Guard master sergeant, and dozens of volunteers are creating a nonprofit group to fundraise a planned $21 million to crate a "wellness and recreation center for wounded warriors in the Adirondack foothills."  The article says Mannarino, who is divorced from her husband, a Vietnam veteran who became "a different person" once he had PTSD, "envisions Patriot Hills of New York as the first Armed Services Recreation Center geared to National Guard members and the treatment of military-related maladies," including PTSD.  As the article mentions, "The concept of combat veterans recovering through recreation and professional therapy is innovative and timely," said Mannarino," and adds,

"Patriot Hills would be a therapeutic mountain resort for National Guard soldiers and others who return from war or are diagnosed with trauma. It would give them access to sports and entertainment, but also counseling in a relaxing environment."

This sounds like a great idea.  The National Guard in particular seems underserved, nationally, and we wish this project and Ms. Mannarino, every success.  It will not be the only initiative of its kind: several private initiatives have sprung up over the last few years, but their current status is unclear.  There's the proposed Veterans' Village in Guerneville, California, which is currently getting opposed by its NIMBY-conscious neighbors; and The Sanctuary for Veterans and Families, envisioned by Stacy Bannerman, author of When the War Came Home: the Inside Story of Reservists and the Families They Leave Behind, which seems to have stalled out, either temporarily or permanently.

British Poetic Verse about PTSD

A smart lad and upstanding too
decided what he'd like to do
of years he had, he'd spend a few
protecting the likes of me and you

His friends all thought him barmy
when he signed up for the army
got a uniform and he was trained
he played in all the army games

Then off to war this boy was sent
proud member of his regiment
but soon was shamed by things he did
his job forced him to kill small kids

The things he saw in battle zones
made this boy wish he'd stayed at home
the things his comrades often said
the times he almost wound up dead

He didn't easily take fright
but being shot at every night
landmines, missiles, homemade bombs
attacked, it seemed by everyone

Call it shell shock
call it battle fatigue
post traumatic stress disorder
it's really all the same to me

There had been no preparation
for this mental situation
he had chosen his vocation
now he can find no consolation

Now all that keeps him calm
in a world he's sure will cause him harm
a firearm by his side
his sanity has been denied

Every night the nightmares come
his friends all fear what he's become
he tries to live on civvy street
suspecting everyone he meets

We trained him up, we taught him well
now every day he goes through hell
every night his mind in shreds
where's the cure to fix his head?

-- Anonymous

Editor's Note: If you happen to know who actually wrote this, please let me know so I can attribute it correctly.  But no guesses, please.

Army Ranger Writes Book about Fighting Two Wars - with Insurgents, and with PTSD

There's a new book out called Two Wars: One Hero's Fight on Two Fronts - Abroad and Within, by Army Ranger Nate Self (great name, on both counts).  It's already #3 on Amazon in books about PTSD - the rest are more typically clinically oriented texts about coping with combat trauma and PTSD, such as you'll see in the left hand column on this blog.  This one is written by a highly-decorated Army ranger (Purple Heart, Silver Star) and West Point grad about the two battles he's fought: one in Afghanistan and Iraq, with insurgents; the other on the home front, with PTSD.  I just learned about it today so haven't had a chance to look at it yet, but be forewarned - it appears to have a spiritual/religious angle to it, in terms of his recovery, and it's published by Tyndale House, which is typically known as a religious book and Bible publisher.  "Not that there's anything specifically wrong with that" - unless of course you'd rather know that in advance, which I certainly would.  Still, major kudos to Nate Self for a) recovering enough to tell his tale; and b) telling it in real time, when it can still help a lot of people, especially those who view life most through the prism of religion-based spirituality.  My guess is it must be pretty good to have already vaulted to #3 in its category on Amazon, although I'm sure the video helps, because that's a very wise marketing move indeed.  To the best of my knowledge, this is the first and only book written by an OIF/OEF veteran about his or her battle with PTSD, and subsequent -- what I'm assuming is -- recovery.  It will be great to take a look at this; and I'm hoping it helps a lot of people.

"Two Wars" by Army Ranger, Nate Self (book Trailer)

The Blunt Truth: Combat Veterans, PTSD and Medical Marijuana

There's a great article on the Web from the Salem (Oregon) News-Record of June 11, 2007, called "Marine Combat Vet Discusses Iraq, PTSD and Medical Marijuana," linked here.  The former Marine in question is Nicholas Burgin, and the subhead to the article is, "The courage of an Iraq War veteran continues in his honesty about PTSD."

In the tradition of Tony Neff's story, "All I Want is What I Deserve," about getting his veterans benefts for a service-connected disability, linked here, Nicholas Burgin's story is another great, first person narrative account of his experience, and what actually happened to him.  (We're in the process of seeing if we can get Burgin's permission to reprint his story in full, here, because it would help so many readers.)

In the meantime, read his story, while it's still up on the Web, or save yourself a copy of it, for future reference.  It's powerful.  And don't neglect reading the comments section, either, that follows the article.  A whole lot of people checked in and said they knew what he was talking about, and they agreed, from Vietnam vets through other OIF/OEF combat vets.

Burgin is a young Marine who, like a highly decorated Marine with PTSD we've blogged about here, Daniel Cotnoir, worked in mortuary affairs for the Marines in Iraq - a more gruesome job hardly exists -- and saw enough stuff to last a thousand lifetimes.  Later on, of course, Burgin had trouble with the memories, and despite trying everything recommended to him, found one and one thing only that helped him ease the pain.  He details his struggles, and his victories, in the excellent, first person narrative, and closes with the line, "Take what you will from this story, but I know for a fact marijuana has saved my life numerous times."  Good for him.

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In the 60s, draft dodgers and anti-war types in the U.S. made their way to Canada to ride out the Vietnam war.  Many stayed for years.  Today, with an all-volunteer military, "escaping" to Canada isn't nearly so popular; but if anyone compares the drug laws in the U.S. and Canada re: marijuana use, and finds themselves overly hassled by the perspective in the U.S. that it's still a criminal offense, they might start to find Canada more attractive again.  Depending on whether the party in power is liberal or conservative, their drug policy waxes and wanes, but more than 51% of Canadians are in favor of decriminalizing marijuna use, says the BBC, and using is often treated differently there than selling (possession v. intent to distribute).

The Double Whammy: Women Combat Veterans with PTSD and Military Sexual Trauma

What's blowing up right now -- on the Web -- in terms of searches, within combat trauma and PTSD: definitely this one. People, the VA included, are looking for resources on treating women combat veterans who are victims of Military Sexual Trauma (MST) (see our index to entries discussing that, linked here). 

That means one of two things (prediction coming): either there's a scandal brewing, and about to hit the news, on this topic; or, the VA and others are fairly well bereft of resources and wondering how best to treat sufferers of this problem, who are apparently reaching the VA in greater numbers.  (One possibility: news items like this that show studies recently have shown an unsurprising but nevertheless unfair disparity in care between men and women veterans.)

Unfortunately, this is another case where civilians have a better situation going for them than the troops do.  In the civilian world, women can take their employers to court for providing a sexual harrassing or otherwise hostile work environment, and their victories in this arena put other employers on notice not to go and do likewise.  Sadly, the troops have no such protection.  It's completely a double whammy: combat trauma AND trauma from rape or other sexual crime.  Women servicemembers who've been affected by it say that in their minds, predominantly, the military sexual trauma is even worse than the PTSD, though they often occur together. 

It's clear we don't have a handle yet on treating PTSD; unfortunately, PTSD concerns even more people; and MST is probably further down the list of where resources are focused right now.  But whether through growing public awareness, better reporting, or for whatever reason, if searches are any indication, the VA is in a quandary about how best to treat MST, and even who the experts / what the resources are.  We wish them, and particularly those who have been injured and mistreated in this manner, all the best, and hope the situation resolves positively, and quickly, for our women veterans, who have been doubly injured.

PTSD, Puppies and Misplaced Values - We're Having the Wrong Conversation, America

Now that media coverage of SSgt. Travis Twiggs -- the five times-deployed Marine and gen-u-ine American hero who killed himself recently after a protracted and unsuccessful fight with PTSD -- has safely faded from view, America can go back to talking about what really interests it - like the Marine tossing the puppy off the cliff in Hawaii.  Here's a great quotable quote from Kathie Costos, a senior chaplain with the International Federation of Chaplains and a longtime, tireless advocate for veterans with PTSD, both personally and professionally on her blog, WoundedTimes, linked here.  After noting that a mention of the news update on "that jerk" with the puppy toss sent blog traffic sky-high, Costos said, most quotably -- "I hate the fact a puppy toss gets more attention than a Marine killing himself because the DOD and the VA won't do what they are supposed to do."  Amen, sistah.  (I don't believe that she's talking about the Twiggs case there, specifically, but just in general.)

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On this blog here, other than news about Travis Twiggs, which people were searching for because they cared about him, what really sends the hit meter aflying is any mention of THTIOKARR -- The Hotness That is Otherwise Known as Rudy Reyes -- who I mention from time to time only because, other than the obvious (hotness!!!), he seems to be an interesting amalgamation of "yin" and "yang" -- the reflective, centered, holistically-minded, nevertheless deadly warrior.  (Sort of the Bruce Lee Lite for our generation, or if Bruce Lee were a veteran, that sort of thing.)  That gives me hope that he's processing his own stuff, whatever that may be, from combat in as effective a way as possible, and being somewhat of a guiding light to others who have shared his experience.  On the other hand, I'm pretty sure people are just searching for photos of Rudy Reyes -- and where they're coming from is often fairly entertaining (defense installations everywhere, and multiple foreign countries, as well as our own.)  I enjoy learning news about Rudy Reyes, however faint, as much as the next person; or cringe over more news about the deranged puppy-tosser, but here's some veterans news we actually SHOULD care about, and it's happening NOW, and it affects us all:

From Brian McGough, at VoteVets, quoting Anne Weismann, general counsel for Citizens for Reponsibility and Ethics in Washington [CREW], in a blog entry linked here:

Today, [Citizens for Responsiblity and Ethics in Washington] CREW received a truly remarkable response from the Department of Veterans Affairs (VA) to its Freedom of Information (FOIA) request for documents relating to the VA’s abhorrent practice of under-diagnosing PTSD in veterans to save money. According to the VA, CREW is not entitled to a fee waiver -- meaning it has to pay for the costs of finding and copying responsive documents -- because there is no longer any public interest in this issue! Ignoring the wealth of news articles triggered by CREW’s and VoteVets.org's release of an internal VA email and the congressional hearing that release prompted, the VA claims that any records CREW requests “would not reveal anything new.”

(Those VA emails are at the heart of a Federal court case in San Francisco, put on by two veterans' rights groups suing the government over better care.  The judge in the case certainly seems to think they're relevant -- perhaps there are more, and that's why the requests were spurned.  Hey, can they even DO that?  They shouldn't be able to...)

But those don't seem to be the topics we're "alarmed" about -- how PTSD from combat trauma can be so bad it can kill you, and how the healthcare system in place to tend to veterans when they come back needs to do a better job of fully taking care of them.  No, instead we're searching for what amounts to celebutainment, and leaving the weightier matters -- for whom? If not us, who? It better be us, and all of us -- there isn't actually anyone else but us who oughta be caring, and who it concerns.  You don't have to actually put on combat boots to "get" that veterans are being underserved, particularly in the area of healthcare (TBI, PTSD, MST) and benefits (foreclosures! the GI Bill), and that it's up to us to care enough about it, that we do something about it, as a nation.  We CAN do that.  Otherwise, the note scrawled on the white board in the photograph, above, in Iraq, is really going to be our epitaph.  America isn't at war -- we're at the mall.

Editor's Note: Sign the petition for the new GI Bill, here. Love the slogan: "We sent them to war.  Why can't we send them to college?"  Why, indeed.

Israeli Military's Proactive Plan for Identifying and Treating Soldiers Who Have PTSD

Here in the U.S., in our usual myopic way, we can get bogged down in the news about returning servicemembers with combat trauma and PTSD and forget just how many other countries in the world have struggled with this problem as well, and often found their own solutions.  Internationally, Japan, Israel, Australia, England and Canada frequently search the Internet for news about who's doing what, and what's working, for treating PTSD worldwide -- according to data from Google's analytical trends.  Today, the Jerusalem Post has an article about how Israel's Defense Ministry is about to unveil a plan for evaluating and treating soldiers systematically who have been exposed to PTSD as part of their military service.  (The article in question is linked here.)  Their expectation is that 2,500 Israelis suffer from PTSD, in a country where military service is compulsory, and conflicts in the region frequently boil over into sustained violence. 

The significance of the Israeli announcement is that the soldiers will be treated according to a "set psychological and medical format," meaning systematically and methodically.  Their understanding is that PTSD treatment succeeds better if initiated earlier, so evaluating all soldiers soon after military service will increase the chances of favorable treatment outcomes.  According to the article, three years ago the military started thinking through how to create a protocol that would involve every soldier, and optimize chances of finding and treating PTSD.  The protocol was developed by Zeev Waisman and Dr. Dan Dolfin.

Two interesting comments from the article express a vision that the U.S. might be wise to emulate:

"A soldier who comes out of battle will immediately be evaluated and we will see what type of treatment he needs," Waisman said. "Nothing is done today in a regulated fashion and we want all treatment to be according to a protocol."

The process begins by inserting the soldier's profile into the system which will then offer several courses for treatment that could include medicines, psychological therapy, family therapy, sex therapy and others. Waisman said that the Ministry of Defense hoped to convince other organizations to adopt the new format which will be evaluated in two years.

Stateside, it's not even clear that the various branches of the Armed Forces share a similar protocol for identifying and treating PTSD -- most likely, they do not.  With far more servicemembers at risk for PTSD than the Israelis have, we could do worse than to imitate what the Israeli Defense Ministry is putting into action as a plan to deal with PTSD, and return exposed servicemembers to better mental and emotional health.

Survivors Quilt: Combat Veterans Patch Meaning Together in Quilts about PTSD, War and Loss

You've heard of survivors' guilt - here we've got survivors' QUILTS.  (Bad pun, I know -- but true.)

We've been talking a bit lately about art therapy, and how combat veterans with PTSD use it successfully to tap into, and work through, some of the pain they feel inside. The photos here, by Mike Kane, at the Seattle Post-Intelligencer, are from a story published on March 19 about how the inpatient PTSD program at the VA hospital in Seattle has a "wall" of quilt squares, made by combat veterans, and encouraged by a nurse, Betsy Shapiro (she's at right, above), now retired, who gave deeply hurting veterans 6x6" cotton squares, on which to draw something or paint something that related to their experience: something they could leave behind, to let others know about them and what they had gone through. 

Initially, there was moaning and groaning, and reluctance to comply.  But shortly thereafter, everyone produced something, and the results were really pretty impressive.  The veterans also gave input into how they wanted the resultant squares displayed -- not set in pretty frames, like squares in a regular patchwork quilt might be, but together, side-by-side, touching.  The article, by Mike Barber, is called "Veterans tell stories in patchwork of memories," and it's linked here.

In an earlier article, from the Honolulu Advertiser from October 2, 2007, linked here, Glenn Reys, an Air Force vet in Honolulu worked through his recovery from drugs and alcohol by immersing himself in making a Hawaiian quilt, symbolic of his homeland, but also incorporating patriotric U.S. symbols.  He found himself devoted to the practice, and able to quilt for hours at a time.  "This kept me busy," Reys said. "When I do sewing like this, I can sew for like six or eight hours, and it's no problem. That's what I do in my continuing recovery."

In one of the best articles I've read about a Vietnam vet, Cecil Ison, struggling with PTSD, the author, Kathy Dobie, talks about visiting his home in Kentucky and watching his wife, Bet, a quilter, work on a quilt with Vietnam themes. Cecil and his two brothers all served in combat in Vietnam, and each responded in a different way.  Cecil's wife, Bet, attempted to capture her view of what they suffered in the quilt, turning an abstract -- feelings about the war, and the isolation it produced -- into something very concrete -- the quilt. She says that the quilt is too painful for Cecil to address directly, but through it, she is able to give vent to some of her feelings, about what she has watched her husband and his brothers go through.  Kathy Dobie writes:

[Cecil's wife, Bet, and I are spending time one afternoon.] We’re talking upstairs in the sewing room while she works on her Vietnam quilt. The room is stuffed with fabric: tweeds, cottons, velvets, hundreds of men’s ties. Bet sews at a small table by the window. She listens to oral histories of Vietnam veterans as she works. On the left side of the quilt is an army-green map of Vietnam, showing the three cities where James, Cecil, and Arnold served. The rest of the quilt is blue, and three male figures float there, separated from one another and bearing labels: anger, despair, and guilt. The quilt reads: "my husband and his brothers came home from vietnam…three islands in an ocean of silence."  James is the Angry one, Cecil the figure of Despair, and Arnold is Guilt.

(This is the quilt in question, pictured to the right.  From top to bottom, you can see "Anger," "Despair," and "Guilt," and "Vietnam" is written lengthwise, on the left.)  Quilt copyright Bet Ison.

Below is another quilt with Vietnam imagery by Bet Ison.  Both quilts are copyright Bet Ison, and property of the author.  Photos are shared with Bet Ison's permission.

(The article by Kathy Dobie article in GQ, is called "The Long Shadow of War," and we blogged about it earlier, here.  Dobie is also the author of the excellent article in the Nation, recently, called "Denial in the Corps" -- about Marines and the stigma of mental health issues, including PTSD, which we've also blogged about, here.)

Quilting is a uniquely American tradition.  Not that other countries haven't had their own versions of it, but it's uniquely tied up in the "fabric," as it were, of American history.  There are so many examples, from crazy quilts made of just scraps of silk, satin and wool garments, patched together on wagon trains as Americans headed West, to quilts made from flour sacks by pioneer women, to Civil War era "album quilts," to today's photo transfer quilts.  Quilts are often about "making do" with just the materials available, and there's something therapeutic about the needlework involved.  In 1837, American writer Nathaniel Hawthorne wrote in The Scarlet Letter, "Women derive a pleasure, incomprehensible to the other sex, from the delicate toil of the needle."  Well, by the 1970s, even he-men like football great Rosey Grier had picked up the needle, though not necessarily to quilt (he favored needlepoint instead).  Quilting is an unusual 3D art form that combines texture (the fabric, and the stitchwork) with color and design, and has a long and storied American history, besides.  It's interesting that combat veterans and their loved ones would find an outlet for some of their feelings in quilting.  Whether it's a square, a bed quilt, or a wall hanging, quilting allows for freedom of expression, and a form of "art therapy" that may just help those who are hurting to focus and transform their experience into something physical that they can share with others. 

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Editor's Note: If you want to continue this conversation about quilting and paying homage to a combat experience, your own or someone else's, email tributequilts AT gmail DOT com. 

"Give an Hour" Helps Fill Veterans Counseling Gap

Give an Hour -- the foundation that matches member psychogists and counselors with veterans and their families in need of counseling at no charge -- to fill the currently unmet gap in mental health services, has been in the news recently.  (You can learn more about Give an Hour's founder, Barbara V. Romberg, Ph.D., in her bio, linked here). It's truly fantastic to see this public-spirited act of service on the part of Give an Hour; at the same time, it's a shame that private industry, so to speak, has to jump in to fill the unmet gap of mental health care -- the need for which care is an entirely predictable "soft cost" of going to war.  Nevertheless, good stuff, and very altruistic and forward-thinking on the part of Dr. Romberg and her organization.

From a press release:

The American Psychiatric Foundation, Lilly Foundation And Give An Hour Join Forces To Provide Mental Health Care To Iraq And Afghanistan Veterans

Heeding the call of a growing public health crisis -- the unmet mental health needs of returning soldiers and their families -- Give an Hour (GAH) and the American Psychiatric Foundation (APF) announced a major expansion of a nationwide effort to help U.S. veterans returning from Iraq and Afghanistan.

GAH and APF, the philanthropic and educational arm of the American Psychiatric Association (APA), will be using a $1 million grant from the Lilly Foundation to recruit and educate volunteer mental health professionals, who will become part of a network aiming to bridge the gap in mental health services for soldiers returning from service, as well as their families. Among troops returning from Iraq and Afghanistan, approximately 40 percent of soldiers, a third of Marines, and half of the National Guard members report psychological problems, but mental health services are in short supply.

"This all-volunteer effort provides badly needed support to help our veterans, many of whom come home with mental health needs," said U.S. Representative Steve Buyer (R-Indiana), Ranking Member, House Committee on Veterans' Affairs. "I applaud the hard work of Give an Hour, the American Psychiatric Foundation, and the Lilly Foundation, which are stepping up to help those who have selflessly served."

Efforts will be made to create a large, national, volunteer network over the next three years to address postwar mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), drug abuse, anxiety and depression.

"This grant will allow us to get out the message that help is available. We want to normalize what our military personnel and their families are experiencing and support the sacrifices that they are making by providing critical mental health support at no cost," said Barbara V. Romberg, Ph.D., founder and president of GAH. "We will be educating the military community and broader public about these mental health needs in hope of helping veterans keep their lives and families intact."

GAH is recruiting mental health professionals to volunteer one hour each week for a minimum of one year to provide direct services in person, by phone or in consultation with schools and community organizations that serve the military community. Services are wide-ranging and include marital and family therapy, substance abuse counseling and treatment for PTSD. APF brings strong ties to the psychiatric community and is actively encouraging psychiatrists to join the network.

"This grant will help us reach our goal of recruiting 10 percent of the 400,000 mental health professionals in the United States by 2015 to assist in this effort," said Dr. Richard K. Harding, M.D., president of the APF. "It is an ambitious goal, but we are confident it can be achieved."

The Department of Defense (DoD) is making an unprecedented attempt to encourage personnel to seek mental health treatment, but a significant increase in demand, in some areas, has forced the rationing of services, created long waiting lists and limited individual counseling sessions. In addition, some members of military families such as parents, siblings and unmarried partners do not qualify for care through the Veterans Administration or DoD but are affected nonetheless by the mental health of the veteran.

"We're privileged to be able to give something back to our troops, but we know there's still much more to be done," said Steven Paul, M.D., executive vice president for science and technology and president of Lilly Research Laboratories. "Lilly is fully committed to assuring that the best possible medicinal treatments are available, but unfortunately, we also know that having access to the best care -- in this case mental health services -- is essential."

About Give an Hour
Give an Hour is a nonprofit 501(c)(3), founded in September 2005 by Dr. Barbara V. Romberg, a psychologist in the Washington, D.C., area. The organization's mission is to develop national networks of volunteers capable of responding to both acute and chronic conditions that arise within our society. Currently, GAH is dedicated to meeting the mental health needs of the troops and families affected by the ongoing conflicts in Iraq and Afghanistan. Give an Hour now has approximately 1,200 providers across the nation and continues to recruit volunteer mental health professionals to its network. For more information or to volunteer to become part of the effort, please visit http://www.giveanhour.org.

About The American Psychiatric Foundation
The American Psychiatric Foundation is the charitable and educational subsidiary of the American Psychiatric Association. The mission of the foundation is to advance understanding that mental illnesses are real and can be effectively treated. For more information, please visit the foundation's web site at http://www.psychfoundation.org.

About Lilly
Lilly, a leading innovation-driven corporation, is developing a growing portfolio of first-in-class and best-in-class pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers -- through medicines and information -- for some of the world's most urgent medical needs. Additional information about Lilly is available at http://www.lilly.com.

From Give an Hour's website:

Our Mission
Our mission is to develop national networks of volunteers capable of responding to both acute and chronic conditions that arise within our society. Our first target population is the U.S. troops and families who are being affected by the current military conflicts in Afghanistan and Iraq. Give an Hour is asking mental health professionals nationwide to literally give an hour of their time each week to provide free mental health services to military personnel and their families. Research will guide the development of additional services needed by the military community, and appropriate networks will be created to respond to those needs. Individuals who receive services will be given the opportunity to give an hour back in their own community.

Our Focus
Our organization is currently focusing on the psychological needs of military personnel and their families because of the significant human cost of the current conflicts. Over 1.6 million troops have been deployed in Afghanistan, Iraq, and the Persian Gulf since September 11, 2001. Nearly 550,000 of these troops have been deployed more than once. According to the U.S. Department of Defense, as of May 15, 2008, nearly 4,600 American troops have died in Iraq and Afghanistan. Roughly 32,875 U.S. troops have been injured during these conflicts.

In addition to the physical injuries sustained, countless servicemen and servicewomen have experienced psychological symptoms directly related to their deployment. According to a RAND report released in April 2008, over 18 percent of troops who have served in Iraq and Afghanistan--nearly 300,000 troops--have symptoms of post-traumatic stress or major depression. At the same time, about 19 percent of service members reported that they experienced a possible traumatic brain injury. And let us not forget: millions of Americans belong to the families of these servicemen and servicewomen. Spouses, children, parents, siblings, and unmarried partners of military personnel are all being adversely affected by the stress and strain of the current military campaign.

Our military leaders are well aware of the human cost of this campaign. Indeed, they are attempting to address the psychological needs of the troops through a variety of programs within the military culture. Unfortunately, the tremendous number of people affected makes it impossible for the military to respond adequately to the mental health needs in its greater community. For example, according to the RAND study, only 43 percent of troops reported ever being evaluated by a physician for their head injuries. Moreover, returning combat veterans suffering from depression, anxiety, and post-traumatic stress disorder (PTSD) are not routinely seeking the mental health treatment they need. RAND also reports that only 53 percent of service members with PTSD or depression sought help over the past year.

A major barrier preventing military personnel from seeking appropriate treatment is the perception of stigma associated with treatment. Many fear that seeking mental health services will jeopardize their career or standing. Others are reluctant to expose their vulnerabilities to providers who are often military personnel themselves, given the military culture’s emphasis on strength, confidence, and bravery. Servicemen and servicewomen might be more inclined to seek help if they know that the services provided are completely independent of the military. By providing services that are separate from the military establishment, we offer an essential option for men and women who might otherwise fail to seek or receive appropriate services.

We are also offering services to parents, siblings, and unmarried partners who are not entitled to receive mental health benefits through the military. Although these individuals may have access to mental health services through other means, they are less likely to seek the help they need and deserve if that help is difficult to find or costly. Our goal is to provide easy access to skilled professionals for all of the people affected by the current war. The participating mental health professionals offer a wide range of services including individual, marital, and family therapy; substance abuse counseling; treatment for post-traumatic stress disorder; and counseling for individuals with traumatic brain injuries. Whether it is a young military wife who is anxious because her four-year-old has had nightmares since her husband’s deployment or a father who is struggling to cope with his son's loss of a leg as a result of an explosion in Iraq, both will receive the assistance they need to move through their experience. The healthier the support system for the returning troops, the lower the risk of severe or prolonged dysfunction within these military families.

Our Plan
Give an Hour is reaching out to the military community in several ways. As a member of America Supports You, a Department of Defense program that provides opportunities for citizens to show their support for the U.S. Armed Forces, we are identifying individuals involved in post-deployment processing of returning troops. We are developing collaborative relationships with the commanding officers of returning troops so that these officers are aware of and comfortable with the services we provide. We are also working closely with a number of veterans service organizations to promote our services directly to the family members of troops. Furthermore, we are working with individuals affiliated with Walter Reed Army Medical Center in Bethesda, Md. We are also collaborating with the Veterans Administration to distribute information about our services through Vet Centers across the country.

Finally, we are promoting our services to the military community and the public through a media campaign that includes print, television, and radio coverage. In fact, our founder and president, Dr. Barbara Romberg, has been interviewed in national media outlets from the Washington Post to NPR's Diane Rehm Show, Ladies' Home Journal, and HD Net's World Report.

Give an Hour recruits mental health professionals in several ways. We have been endorsed by the American Psychiatric Association and the National Association of Social Workers and are seeking endorsements from other major mental health organizations. Only licensed mental health professionals are included in the network. Licenses are verified. Non-licensed pastoral providers may be included in the network as long as they meet other criteria, including membership in professional organizations. In addition to coordinating with national organizations, we also recruit mental health professionals through professional publications and Web sites.

As of May 2008 we have a redesigned Web site, expanded to include materials to guide visitors seeking services as well as reference materials to inform mental health professionals. Only mental health professionals trained and experienced to work with trauma victims will identify themselves as available to work with soldiers who have experienced combat. We are working with experts in the trauma field to prepare materials for our Web site and to find appropriate mental health professionals for recruitment.

The Eli Lilly and Company Foundation recently awarded Give an Hour, in partnership with the American Psychiatric Foundation, a major grant that will allow us to spread our message to the leaders of the mental health community in every state. 

We are recruiting volunteers from a number of organizations and institutions as well as through our Web site to assist us in the implementation of our program. Volunteers from retired military personnel to members of military families to concerned civilians throughout thte country are helping Give an Hour. Volunteers are checking licenses, distributing brochures, and coordinating community partnership opportunities for those troops and family members interested in giving back an hour to their own community.

Our Vision
Our primary focus will always be to attend to those in need by linking them to individuals in our society best equipped to respond effectively. In addition, we will develop research and educational programs to further promote the value and importance of a new kind of volunteerism. We hope to encourage an increase in shared responsibility for those citizens who are suffering. We need only look at the outpouring of aid and support following both the terrorist attacks of September 11, 2001, and Hurricane Katrina in August 2005 to see the potential we have to become a truly compassionate and united nation. And we need only look at the significant costs of the war in Iraq and the relief efforts for Katrina’s victims to see that federal and state governments are already strained beyond their means. We have not only the potential but the duty to help one another in times of need.

For more information, contact Barbara V. Romberg, Ph.D., Founder and President, Give an Hour.  Her email address is linked here.

"Art Relaxes Me" - Combat Veterans Using Art Therapy to Heal

We've blogged recently about the potential for art therapy to treat combat trauma and PTSD -- not instead of other types of therapy, but in addition to them -- here and here.  One very good article from about a year ago is worth including in the discussion.  The article, by Jackie Spinner, was published April 15, 2007 in the Washington Post, and it's called "War's Pain, Softened with a Brush Stroke" and linked here.  (Spinner herself is the author of, Tell Them I Didn't Cry: A Young Journalist's Story of Joy, Loss and Survival in Iraq, linked here.)  The article talks about how combat veterans have been helped by art therapy, in finding ways to express what's happened to them that brings them a modicum of peace and transformation.  It also talks about the great downturn in the availability of art therapy for PTSD, after its heyday in the 1970s, with the Vietnam war -- which is a shame, because to those it helps, it's really been quite beneficial.  A very few combat veterans are able to take art therapy classes through the VA; but far fewer than in past years, primarily because of budget cuts.  Apparently just like in the public schools, art is one of the first items to be cut when budgets are trimmed. If you read the article, though, you'll gain an appreciation for just what it provides -- and wish more veterans had the opportunity to experience it.  As one injured veteran said, speaking for many, "Art relaxes me..."

Sweet Dreams Are Made of This - One Potential Coping Tool for PTSD's Nightmares

"To sleep, perchance to dream..." said Hamlet in his famous soliloquy, in the Shakespeare play of the same name.  It's not so much the dreams PTSD sufferers are worried about, it's the nightmares that bring bad memories rushing back, or otherwise destroy a night's sleep. People with PTSD can be so agitated about their nightmares that they try to put off sleeping altogether, numbing themselves first with drugs or alcohol to keep the nightmares at bay.  (Of course, that creates more problems than it solves, but it's perfectly understandable why that might happen.)  (That's an EEG diagram of healthy, uninterrupted sleep, by the way, at left.)  Now, one novel technique, publicized by a military trauma specialist, may hold out some hope to those whose experience of nightmares prevents them from getting a good night's (and restorative night's) sleep, so crucial to good health, psychologically and physiologically speaking.

In an article published in the Air Force Times of August 9, 2007, linked here, Navy Commander and combat psychologist Beverly Dexter, Ph.D. discusses a somewhat controversial concept she's developed that apparently helps some troops sleep better through the night.  The concept is called "planned dream intervention," although it might more accurately be called, "proactive nightmare intervention," because the goal is to keep a terrifying nightmare from interrupting an otherwise good night's sleep -- essentially by seeing it through to its conclusion, the very thing the sleeping person beset with nightmares usually is too terrified to let actually happen.  I have no idea what to make of this whole concept, and whether it's the concept that's confusing, or the article that describes it just not doing a good enough job of conveying how it really works.  Or, maybe the concept itself has some kinks to work through. What sort of universal applicability does it have?  Only to some types of nightmare sufferers, or does it have validity for all?  Would some types of patients benefit more from this than others?  Does it matter how long (in terms of months or years) people have had the nightmares for?  These and other questions are not really addressed in the article.  It sounds like Dr. Dexter herself says that the concept sounds too good to be true, but she claims it really works, and the article lists a number of examples of people who it's helped.  From the article, it also seems like it's generated a certain amount of buzz as a topic, among troops and military chaplains.  Dr. Dexter, whose bio is linked here, is planning a book on the subject, to come out sometime in 2008.  The book's tentative title is "No More Nightmares:  How to Use Planned Dream Intervention to End Nightmares," but it doesn't seem to be in print yet -- at least, Amazon doesn't have it listed.

According to the article, Dr. Dexter served as the chief of the Combat Stress and Readiness Clinic at Al Asad Air Base in Iraq, and works at the Naval Medical Center in Portsmouth, VA when she's not deployed.

Similarities Explored in How Cops and Troops Experience Trauma Cumulatively, Develop PTSD

Lately we've been taking a look at crucial concept in the linkage between combat trauma and PTSD -- the "dose-response relationship," which is apparently a more or less linear relationship between more combat trauma experienced and greater chance of developing PTSD.  (Earlier blog entries on that topic are linked here and here.)

On the Web, every once in a while you find a gem -- some good and useful material -- in its entirety, and one such "find" is Mary Elizabeth Claire's Ph.D. thesis at Drexel University, available online, called "The Relationship between Critical Incidents, Hostility, and PTSD Symptoms in Police Officers."  (The thesis is linked here.)

While we might prefer her thesis to be about combat veterans and PTSD (heh), the reality is, there's quite a bit of overlap or similarity in how police and veterans experience the events that contribute to PTSD, a fact she explains early on, when she writes:

...Although police officers are usually identified with emergency responders, the context in which police officers experience critical incidents is similar to situations experienced by military veterans. Violanti (1996a) identified six areas of police work that are comparable to the experiences of those that served in the Vietnam War: guerilla warfare at home, the identity of the enemy, a continual sense of insecurity, lack of support, witnessing abusive violence, and depersonalization. The first area, guerilla warfare, is similar to the current plight of many police officers. Violanti (1996a) describes police officers as serving in "peacetime combat."

In a segment entitled, Cumulative Effects of Exposure to Critical Incidents, she writes that:

Learning theory suggests that when an individual is exposed to a repeated stimulus, the person either habituates to the stimuli or becomes sensitized to it. When habituation occurs, the individual reduces their responsiveness to the stimuli while sensitization increases and heightens an individual’s responsiveness. Both behaviors are normal responses but how one reacts to a repetitive stimulus often depends on the intensity of the stimulus. A high intensity stimulus generally tends to sensitize a person to the stimulus while habituation occurs when a person is repeatedly exposed to low to moderate stimuli (Barker, 2001).

It is commonly assumed that individuals that encounter traumatic stressors frequently (e.g., police officers, firefighters) habituate to the stimuli, and therefore they are more resistant to the psychological effects of traumatic incidents. However, the opposing view, that the cumulative effect of critical incidents results in more posttraumatic stress symptoms, has become more empirically supported in recent years (Violanti, 1996b). These findings are congruent with the theories of learning since police officers experience high intensity stimuli on a routine basis thus becoming sensitized, not habituated, to the stimuli.

Several studies have investigated the cumulative effect of critical incidents and the development of PTSD symptoms. For example, Stephens and Miller (1998) conducted a study of 527 New Zealand police officers and found a positive relationship between the number of traumatic events and more PTSD symptoms. Trauma experienced prior to joining the police force was not related to PTSD symptoms while trauma experienced after joining the police force was related to more PTSD symptoms.

Martin et al. (1986) reported that 26% of the 56 police officers attending a sensitive crime seminar met criteria for PTSD. Moreover, the authors found PTSD was related to the number of incidents experienced by the officers. The most frequently endorsed symptom "Recurrent and intrusive recollection of the event" was endorsed by 47 % of the police officers. Martin et al. (1986) indicated it is not surprising that this symptom was endorsed most frequently since police officers continually place themselves in situations similar to previous traumatic incidents and have little opportunity to distance themselves from the incident. Likewise, only 11% of the officers reported in engaging in active avoidance of activities. Moreover, sensitization to the repetitive trauma appeared to occur for these police officers as evidenced by the frequent endorsement of hyperarousal and exaggerated startle response.

Mitchell (1999) reported on the qualitative descriptions of 426 officers above the rank of probationer in the United Kingdom. The officers were asked to describe the most memorable critical incident they experienced during their police career. Almost 75% of the descriptions involved death, and almost 33% of the deaths described involved traffic accidents. Although the Lockerbie Disaster and the crash of the RAF Chinook helicopter were frequently reported, traffic accidents were the largest category of memorable critical incidents described. Different occupational groups within the police department participated, however, 60% of the traffic incidents described as memorable and distressing were reported by current members of the traffic division. Thus, it appears that these officers did not habituate to the incidents in which they were commonly exposed, but instead became sensitized to such incidents. Additionally, the length of time since the accident ranged from two weeks to 25 years with a mean of 5.6 years, indicating that time did not ameliorate the impact of critical incidents in this sample.

Neylan et al. (2002) investigated the impact of critical incident exposure on the quality of sleep in 747 police officers from New York, New York, and Oakland and San Jose, California. The investigators found that cumulative critical incident exposure was associated with nightmares, a symptom of PTSD. Furthermore, sleep disturbances were strongly related to PTSD symptomatology and general psychopathology.

Sleep disturbances and how they contribute to PTSD is another well-deserved treatment that we'll have to leave, though, for another time...

A Small, Relaxing Gift You Can Make for Combat Veterans and Their Families

It may not be as great, deep or profound as U.S. Marine Corps Brigadier General Timothy C. Hanifen's suggestions for "Three Gifts You Can Give Returning Veterans That Will Last a Lifetime," which we blogged about earlier, here -- "understanding," "support" and "affirmation" -- but we were surprised by how many veterans enjoyed this particular homemade relaxation gift. 

The gift, pictured in the photo to the left, is a "soothing eye pillow," from instructions in Valerie Gennari Cooksley, R.N.'s great book, Aromatherapy: A Lifetime Guide to Healing with Essential Oils.  The eye pillows, which she says are "great for tension headaches and eye strain," are something I made for a number of friends who were deployed to Iraq and Afghanistan, their families at home, or wounded troops recovering at Walter Reed who I knew, etc. -- and they claimed to find them a welcome, soothing relief that helped them get to sleep -- and later fought with their families over who could keep them.  There were some pretty humorously appreciative comments from guys and gals I worried might find this completely snivel gear (don't ask).  One longtime Marine combat veteran said he achieved nirvana with this -- if only for a moment; another soldier fought with his wife (in a good way!) over it; and a seriously wounded young Marine recovering in Bethesda told his mom, "you can see it -- but you can't have it!  I need it back because I'm going to use it :-)".  So I guess they really were big hits, after all, and simple and pleasant both to make and to give.   

The eye pillows are made from a combination of 1 cup of flaxseed, and 1 cup of dried lavender, then sprinkled with a few drops of lavender essential oil (Aura Cacia is a well-known, reputable brand), which are mixed well, then sewn inside a rectangular, approximately 3 1/2" x 8 1/2" fabric pouch.  Any soft, smooth fabric like satin or even raw silk will do -- just make sure the it's not so fragile that the essential oils will ruin it if they happen to leak through (and they might).  I found it was more fun to use fabric imprinted with the branch of the service: for a while, fabric like that pictured was available nationally, and may still be, at quilt shops like Keepsake Quilting, in Center Harbor, NH.

Don't fill the fabric pouch completely full - you want it to be somewhat flexible and bendable when it's done, so leave a few inches of room at the top when you're holding the filled pouch lengthwise for the contents to move around.  In theory these eye pillows could be laid over your closed eyes while you're resting, but in reality most people seemed to tuck them into a pillowcase or under a pillow for a better night's sleep.

Valerie Cooksley, R.N., is an internationally-recognized expert on aromatherapy, and has written a number of books about it, from a scientific as opposed to a frou-frou perspective, for Prentice Hall, etc.  For years she was a cancer nurse, who later served as a consultant to Tacoma General Hospital in Tacoma, WA, among others, putting aromatherapy to work in a hospital setting (various essential oils are antibacterial or antiviral as well as smell great, so are a pleasant addition in that arena).  She noted that lavender, the key ingredient in the relaxing eye pillows, is used in geriatric settings in England, a few drops sprinkled on pillowcases at bedtime, to help the oldsters have a more peaceful night's sleep.  In the back of her book, she mentions that the psycho-emotional benefits of lavender are that it helps with nervous tension, balancing emotions, irritability, insomnia, stress, anxiety, is soothing to the nervous system, and helps with exhaustion.  Since one of the hallmarks of PTSD is sleeping poorly, a simple item like this, to tuck into a pillowcase at night -- even that of a family member -- might be a pleasant and welcome small gesture.

In future posts, we'll discuss some of Valerie Cooksley's essential oil blends for grief and bereavement, among others -- some of the ingredients have historical significance as well (think of the story of the three kings bringing gold, frankincense and myrrh -- two of those three are essential oils.)

SSgt. Travis Twiggs - Well-Loved U.S. Marine and Hurting PTSD Hero - the Update

It's nice to know that the exceptionally tragic story of PSTD sufferer and well-loved Marine SSgt. Travis N. Twiggs hasn't completely faded from view -- a story we broke here, days before the national media even picked it up.  This weekend it looks like the Times-Picayune has a two-part series about Twiggs on the NOLA.com website, linked here, and the story is both well-written, and contains - gasp - actual reporting, including conversations with the dad and stepmom, both Louisiana residents.  (The Twiggs brothers spent their formative years in Ama, Louisiana.)  It's a shock to me that CNN never covered the Twiggs story -- although they did cover the story of the Marine on leave who was murdered over $8 in his pocket.  I guess the fear-mongering, anxiety-producing shock value of that "news," while terrifically sad in itself, beats the prospect of actually covering a story with some complexity and depth, in which we as Americans could stand to learn more about the life and background of an American hero whose death we mourn.  Weird values, CNN (or maybe complete lack of them...)

One nice development since our original reporting on this story, back in mid-May when it happened.  The Marine Corps Gazette, which originally published Travis Twiggs' story about his battle with PTSD, put the article back in print.  It's available on their website now, linked here.  And they added a nice little blurb about mourning his passing and extending their condolences to his family, which is appropriate.  It also sounds like there was a Memorial Service for the extremely well-loved Staff Sergeant at Quantico a week ago, which allowed his fellow Marines and those he'd come in contact with over the years, to pay their respects.  Also a very nice, and well-deserved touch.  (So much better than just sweeping the whole situation under the rug, because it had such a tragic ending.)

Other nice developments include hearing more from Travis Twiggs' wife, Kellee, about her husband's ongoing and difficult battle with PTSD.  We've blogged about her here and here, and those entrees are well worth reading, to learn more about the spouse and family's battle with PTSD, since it ultimately involves them very much.  Kellee is an impressive American hero herself, and their two lovely girls will now grow up without their dad -- and with undoubtedly many questions about why he had to die -- because of this terrible opponent he faced, which ultimately defeated him.  (And don't think they won't struggle with that: research has shown that PTSD does have consequences into future generations.  We've blogged about that elsewhere here.)

It turns out that Kellee Twiggs and Travis Twiggs went way back, and had known each other since childhood, though married for the last decade. In other words, a wife who really knew her husband, and what was, or wasn't, normal for him to be like, behavior-wise.  I still remember some of her first words from a tv report, on learning of her husband's violent death in Arizona.  It's from an audio clip, and she's obviously upset, and her words at the end just trail off, like she's debating about whether she can even say what she's wanting to say. The quote?  "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..." To do what?  Here's where it gets so difficult...

To listen? PTSD sufferers often don't want to talk about what they're really going through.  A note from someone who was undergoing treatment with Travis at Bethesda let me know that as great a guy as Travis was, and he really WAS, his friend emphasized, he definitely didn't want to talk about his down times.  To treat it?  Sounds like Travis Twiggs had gone through multiple forms of treatment for his PTSD, but none of them were effective -- and that's pretty par for the course, in some ways.  The current thinking seems to be, hand someone a handful of pills -- at one time, Travis was taking 19 different medications -- and hope for the best.  There was some counseling involved, but it sounds like very little -- and the whole emphasis of the medication is on "forgetting" or "blurring out" (numbing out) the memories -- so when you're on the medication you're pretty much a zombie (his wife speaks of his being -- great made-up word -- in "comatose-dom" while he was on medication), and when you're off, why, the memories of what you're trying to forget just come flooding back.  Intrusive memories (meaning, you get them when you don't want them) are a hallmark of PTSD.

And Twiggs had some memories he was very much trying to forget.  Not things that he was at fault for, per se -- but things that troubled him at the deepest possible level, and for which he felt some, perhaps unfounded, responsibility.  His loss of "two of his boys" --  Lance Cpl. Robert F. Eckfield, Jr., 23, from Cleveland, Ohio, and Lance Cpl. Jared J. Kremm, 24, of Hauppauge, N.Y., who died on October 27, 2005 from an "indirect fire explosion'' in Saqlawiyah, Iraq. (Kremm died at the scene of the explosion, and Eckfield died of injuries later at a battlefield medical center where he was evacuated.)  Twiggs felt, whether accurately and wisely, or not -- the burden of their deaths -- as a form of guilt he never overcame.  And here's where I wonder whether the Marine Corps' heavy emphasis on never leaving a brother behind, while laudable, can also be overdone a bit -- to the point that someone with a sensitive conscience -- for lack of any better way to describe it -- can't manage the pain afterwards of realizing some died on his watch.  "Everything in balance," the Taoists used to say -- and that includes troubling, painful emotions like grief.  In a heartbreaking, terrible situation like this, you can perhaps see why.

I've been reading Raymond Scurfield, DSW lately -- in particular, A Vietnam Trilogy: Veterans and Post-Traumatic Stress: 1968, 1989, 2000 -- and some things really never change, including the nature of combat, and its affects on those who suffer its obvious trauma.  (Scurfield, a social work professor, worked for years with the VA on PTSD, and started his career as a social work medic in Vietnam.)  At the very beginning of his book, he talks about meeting a (deranged) Marine, who'd had a serious psychotic breakdown in Vietnam.  In moments of lucidity, this Marine would plead, in absolute anguish, for Scurfield to help him get back to Vietnam to rescue his buddies -- buddies he had left behind.  But this Marine, unlike Twiggs, had deserted his guys -- or at least believed that he had.  Desertion in the actual military sense of the word.  Not so, Twiggs.  The Vietnam-era Marine cried out to Scurfield the social worker, "I have got to get back!  I let my fellow Marines down terribly [when he broke down and was medically evacuated.]  I have to go back -- to prove that I am a man!  Can you help me, to get back?"  Even 40 years later, you can still hear the anguish of that man's cries.  AND his confusion over whether he'd actually deserted his men, by getting so sick that he had to leave.  Scurfield writes about what a tortured experience that was to go through, because he knew that the man of course was never going to be able to get back, in his present condition, and would likely be broken by the guilt he felt about the matter.  "He could never make right," Scurfield writes, "What I later came to understand, is perhaps the most unforgiveable and egregious shame that can befall any combat soldier -- 'deserting' or otherwise letting down one's buddies in the heat of battle."  ("The image of this tormented soldier stays with me still," Scurfield concludes.)

Of course, Twiggs wasn't guilty of deserting his buddies in battle -- they died because they were attacked, and he was powerless to prevent their death.  But that wasn't the way he looked at it, apparently -- and an additional "head trip," that probably only added to this -- was the event Twiggs talks about in his PTSD essay, where unbeknownst to him, some of the first people he met upon hitting the ground at the homecoming ceremony for his battalion, just back from Iraq -- were the FAMILIES of those two men, who he apparently was not expecting to see.  Apparently seeing them in the midst of an otherwise mutedly joyful occasion just further seared into Twiggs' mind that the reason those guys weren't here with the rest of them was somehow, inexplicably, his fault.

---

I do think this is where the Marine Corps needs to bear some responsibility, unless it already does, for right training on the matter - again, a matter of "balance."  OF COURSE you want to do everything in your power, from boot camp all the way through repeated deployments -- to keep your buddies alive and as safe from harm as you can make them -- but the important points are, taking responsibilty for only what's within your power to have happen (disregarding fate), and, realizing that beyond obviously, we're talking combat here, and people are gonna die.  It seems like both sides of that coin -- care for your brothers, and understanding that not everyone comes back alive -- are equally important, and maybe only philosophical, sophisticated thinkers can balance both sides of that concept at the same time.  I'm not making fun here, a favorite Marine officer who was grievously wounded in Iraq once told me that he thought the ability to balance two contradictions in your mind at once, without denigrating the importance of either, was high intelligence indeed.

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I know that the Marine Corps includes Sun Tzu's famous Chinese classic on the art of military strategy, The Art of War, in its Commandant's reading list -- that every Marine reads through, appropriate to his or her grade -- but it might be a good idea to broaden the exposure to what other Taoists think, since they're such admirable realists about the dual nature of life.  (Curiously, Taoism is such a non-possessive school of thought that someone can be a practicing Catholic, Unitarian, Wiccan, or no religion at all, and not find a conflict of religious "allegiance".)  Here's what one latter-day Taoist philosopher and poet had to say about the compulsive nature of intrusive thoughts and worry, and it relates directly to what Travis Twiggs and others underdo all the time, in combat and its aftermath.  "Worry is an addiction that interferes with compassion," writes Deng Ming Dao in 365 Tao, and continues, "Worry is a problem that seems to be rampant.  ... Whatever the source, it is clear that worry is not useful.  It is a cancer of the emotions -- concern gone compulsive.  It eats away at body and mind."

"It does no good to say," he continues, "'Don't think about it'."  You'll only worry more.  It is far better to keep walking your path, changing what you can.  The rest must be dissolved ... In this world of infants with immune deficiencies, economic imbalance, personal violence, and international conflict, it is impossible to address everyone's concerns.  Taking care of yourself and doing something good for those whom you meet [and serve with?!] is enough.  That is compassion, and we must exercise it even in the face of overwhelming odds [combat?!].  Whenever you meet a problem, help if it is in your power to do so.  After you have acted, withdraw and be unconcerned about it..."  (Not to belabor the obvious, but not "unconcerned" in the sense of "we don't care," unconcerned in the sense that, we've already done what we can, and let's not continue to ruin more lives in the process, with needless worry...)

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Back to Ray Scurfield, for a moment.  Isolation is a hallmark of PTSD, because of the very real risks that NOT isolating yourself from others, in combat, creates.  Unfortunately, it's hard to turn this skill "on" and "off" like a light switch.  But in combat, you bond heavily with others at your (eventual) peril.  It's possible that SSgt. Travis Twiggs, well-loved by his Marines and his family, just didn't "get" this, and it's part of what eventually killed him, when he broke under the strain of his perhaps misplaced guilt and PTSD.  Writes Scurfield, "Indeed, the bonds formed during war can be so powerful that men become closer than brothers.  Unfortunately, this is a two-edged sword.  Brothers-in-arms protect each other, look out for each other, help to get each through the war." "On the other hand," he continues," if something happens to your close buddy, it can be devastating.  Many vets talk about how, at some point during their war tour, they suffered the tragic loss of someone whom they had let themselves get close to; the impact is profound."

Scurfield includes a story from a suffering Vietnam vet who did just that, to drive home his point.  Scurfield retells the story in the man's own words: "I had been warned by some of the seasoned vets not to let other people get close to you -- "because it hurts too much if something happens to them."  In spite of my better judgment, I did get close, real close [to another veteran, during combat] ... [He] and I got closer than I have been with anyone before or since; we became as close as any two people could possibly be."  And, after [his buddy] got killed, I hurt so bad...And I knew right then, I was never going to let anyone get close to me again.  And I didn't. I looked out for number one. Period."

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"A great guy, a horrible tragedy"

Travis Twiggs, who from all accounts was a very big-hearted, loving guy, apparently never did close himself off like the Vietnam vet in Scurfield's account did.  If you know anyone who knows Travis Twiggs, you know that he was a well-loved guy.  His Marines loved him, his wife loved him, his family loved him -- heck even his landlord loved him, and people he'd just barely met -- even when his PSTD was full-blown.  And if that isn't a testament to what kind of guy he was, I don't know what is.  (His landlord in Virginia, "Mr. Bob," as his Twiggs' wife, Kellee, sweetly calls him, the head of a famous international philanthropic organization in the D.C. area, basically broke all land-speed records trying to get the word out, after Twiggs' death, that he was being mischaracterized in the media as a violent criminal, when in fact he was the sweetest and warmest guy imaginable, who literaly would do anything for anybody.  Many who knew Twiggs seemed to feel the same way.)

One of the true delights of having broken this story early was hearing in emails from people who did know Travis, and let's just say for the record -- it was all good.  Here's one of the best ones I received, though, from a professional guy in Washington, D.C., who spent some time in the same ward at Bethesda as Travis Twiggs did, back in March of this year (the same time period where I was trying to get in touch with him, and getting worried about what his silence actually meant.)  Here's what this guy had to say:

"In the two weeks I was there as a patient, I got a chance to know Travis. Travis was a great guy, he had a heart of gold and would befriend anyone. The staff loved him - he had been there the longest (two months). While I was there, I had a few conversations with him - mostly about what his current duty was and his plans for discharge. While he was a outwardly friendly guy, it was clear he was also in a great deal of pain (I never asked him the details of his PTSD - one learns quickly that those are depressed (like me) can talk more openly than those who have PTSD - who typically are reluctant to open up). So, I did not know the extent of his pain, just that he was in alot of pain. When he was in pain, he tended to withdraw. When not in pain, he was quite lively and was always the center of attention. I think he really wanted to get better and heal, but just got caught in a bad situation and did not reach out to those who could have helped. I don't know anymore beyond what I have been told and what I have read. Like I said, he was a great guy and this is a horrible tragedy.

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I know I spent quite a bit of angst in March wondering what had happened to Travis Twiggs, well before his untimely end, and hoping I could get in touch with him -- both to see how he was really doing (I had my doubts), and to see if I could republish his original article from the Marine Corps Gazette, in full -- because I believed it could greatly help other veterans who were suffering.  I got an email back from him -- an autoreply -- mentioning another email address of his, referencing "War Pig."  It made me curious just what was behind this "War Pig" reference -- was his battalion nicknamed that, like Eric Acevedo's had been nicknamed, War Dogs?  (It wasn't.)  Did it have to do with some fondness for Light Armored Vehicles?  (Also nicknamed War Pigs.)  That seems a bit much, even for a Marine :-)  (No, it turns out it wasn't.)  Or did it maybe have to do with some lyrics from an old "Black Sabbath" song called War Pigs, which Twiggs was himself old enough to remember?  But those are pretty anti- at least the insanity of war, pretty un-likely for a guy who'd been a career active duty Marine.  (Twiggs was such a gung-ho Marine that, on top of his five deployments(!), he'd actually left the Marine Corps at one point -- and come back!)

It turns out there's a much better story to what "War Pig" signifies, told by a Twiggs family member.  Apparently when Twiggs served in Cuba, he was up so many days straight being a Marine, doing his duty, that when he finally got to sleep, he slept for literally days.  So long, in fact, that a commanding officer wrote a sign and stuck it over his sleeping form, "Here lies the War Pig."  Indeed.

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It's heartbreaking that Travis Twiggs, straight-ahead U.S. Marine, loving father, husband, son and brother, leader of Marines, hospitable neighbor, friend of many, including those he'd barely met -- lost his painful, deeply personal struggle with PTSD.  It's especially heartbreaking to think of how much of the trouble he suffered seemed to revolve around the loss of his guys -- a loss he would have been powerless to prevent, and for which he had suffered, and grieved, already enough.  The rending cruelty of PTSD is that by his own dying, not only did he not take the pain of his Marines' losses away, but he also actually added to it, with his own.  Now his Marines grieve, but also his family grieves, and everyone has to go forward without him, who was heavily there for others, but ultimately couldn't be so for himself.

There are a lot of lessons from Travis Twiggs' needless death from PTSD, and I don't think we're in any position to realize all of them, yet.  Or to attend to them, and "fix" their consequences, so things like this don't happen anymore.  We're sadly still a long way off from that.  One "clue" in all this was left by Travis himself: that a handful of medications doesn't really work to solve the problem, if the underlying felt problem is guilt.  All the medications do -- besides complicate matters -- is keep the patient numbed out, but not capable of working through his very real torment.  Take away the medications, some of which are probably vital, but not all -- and the torment is right where it was before, more or less unchanged.  More needs to be done to uncover the roots of PTSD -- who gets it, and why, and most of all, how to treat it, successfully -- but whatever ends up being the "magic bullet" will undoubtedly be a combination of things: medication, talk therapy, and even the seemingly far-fetched (see our recent series on Complementary and Alternative Medicine and PTSD).  It would be pretty Taoist to say, whatever ends up helping, let's use it, because what we care about is not what type of solution it is, but how much it helps those who are suffering, in the throes of it.  We can already tell what doesn't work, which is pretty much the status quo: a handful of medications to mix (against the rules) with drugs and alcohol, combat veterans' frequent and very understable choice.

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At the risk of oversimplifying things, what's killing veterans with PTSD is what they can't forget, and what they feel somehow responsible for seeing, doing, experiencing -- or not, in some cases.  It's this responsibilty that may be ultimately wrongly placed.  As combatants, they're just doing the best they can, under the circumstances.  In war, more so than any other situation on earth, it's pretty clear that sh*t happens, and that's hard enough to deal with, without going away thinking for years that it's your fault.  Maybe it's time to cut back a little on the gung-ho warrior's creed of never leaving a brother on any level, because it's messing with people's heads when they ultimately have to, through no fault of their own.  Couldn't at least some sort of balance be taught?  You want to give your all for your brothers (and sisters), but when stuff happens, and you can't, you've done things to the best of your abilty, and maybe you can let it go -- let IT go, not THEIR memories.  Again, a powerfully difficult concept to live -- but nevertheless, an equally powerfully freeing one. "Right thinking" needs to become part of right warfare -- because the casualties of not having that are starting to become really obvious.  Far more young guys (and women, but mainly guys) kill themselves as combat veterans when they just can't take it anymore -- it's much less common when older guys do.  At 36, Twiggs was older than many Marines he served with.  Undoubtedly, he felt that only added to his responsibilty.  But even this week, there are stories in the news about older OIF/OEF veterans who have killed themselves from PTSD -- one is an Army major in the Midwest, who was about to get orders to go back. 

So the horrible finale of PTSD -- suicide -- while primarily a young servicemember's act, is by no means limited to them.  (We're in the midst of blogging about this topic; look for more on this, later.)  We're also dealing with an all-volunteer military that has an average age that is strikingly quite young.  The one career Marine I know who's been deployed almost as many times as Twiggs was, but did get help for his PTSD -- did it because he knew that without it, he was affecting his family too much.  Extremely commendable.  He got the help, and stayed a Marine.  And he's still alive today.  Twiggs, whose case may have been worse, tried some to get help, and couldn't get past what was killing him, despite his love for his family, and his Marines.  It's a sad, sad tale that ends this way, with the crushing feeling that it really didn't have to, but how?!!  I'm glad that more all-encompassing coverage is finally being given to who Travis Twiggs was, not just how he died -- but I can't help thinking about his death, and how, "Here Lies the War Pig," finally getting his rest, at last, is at least as fitting a tribute, as any.

The Dose-Response Relationship with PTSD: More Combat = More PTSD, Earlier Study Shows

"If you aim for simplicity, you must first master complexity" -- said the 17th century Chinese painter, Wang Kai. Almost 400 posts in on this blog, I still enjoy the moments when something profoundly complex like combat trauma is nevertheless reduced to something quite simple to understand.  Here's one such observation: the more combat one is exposed to, the greater the chances of experiencing PTSD.  Makes sense, doesn't it?  Although we've talked about that concept recently on this blog -- with a great graphic that shows the linear relationship quite profoundly, that entry linked here -- here's another, earlier study that says the same thing, in an article linked here.

Researchers who went back and analyzed two conflicting, large-scale studies of PTSD -- one done by the Centers for Disease Control (CDC), the other the National Vietnam Veterans' Readjustment Study -- found, among other things, that although "most veterans who experienced very highly traumatic events did not develop PTSD," still, the more war trauma a veteran experienced, the higher a veteran's odds of developing PTSD.  Researchers called this the "dose-response relationship," and said their work, going back over the two major studies and attempting to reconcile their findings, found that it was "even stronger than previously reported."

SOURCES: Dohrenwend, B.P. Science, Aug. 18, 2006; Vol. 313: pp. 979-982. McNally, R.J. Science, Aug. 18, 2006; Vol. 313: pp. 923-924.

Pick Up the Phone, Hon - That's the VA Calling!

In a seemingly odd, but -- one would hope -- nonetheless proactive move -- the Department of Veterans Affairs (VA) is now placing outgoing calls to in a nationwide campaign to inform and connect returning combat veterans with the services the VA provides.  The calls, which are being outsourced to a provider called EDS, are initiated by the VA and follow a very specific, and laudable intention,  In a PR blurb published on the Web at TCRNet, the following information was provided about the program:

The Combat Veteran Call Center is expected to make more people aware of health care and benefits eligibility for veterans of the wars in Iraq and Afghanistan. It’s the first task order awarded under the General Services Administration’s $2.5 billion USA Contact contract vehicle, according to EDS.

Calls to veterans began on May 1 and plans include reaching out to nearly 570,000 recent wartime veterans over the next six months. The campaign will initially focus on roughly 17,000 veterans who, based on their wartime injuries or illnesses, are considered candidates for care management.

The second phase will include contacting about 550,000 Operation Iraqi Freedom and Operation Enduring Freedom veterans who have not yet enrolled for VA health care services."

Additionally, "Officials at the company say EDS phone representatives will make initial calls to veterans to complete interview that will assess their needs. Representatives also will provide information about available VA health care services and benefits. Follow-up calls will also be completed to ensure that the veteran has had his or her needs met."

 

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At least one Veterans Service Officer I spoke with, while praising the existence of this program, also cautioned that its emphasis on prioritizing contact with OIF/OEF veterans over those of previous wars, could have the unintended consequence of creating friction between Vietnam veterans and Iraq and Afghanistan veterans -- groups which have been reasonably supportive of each others' existence, so far.  In fact, Vietnam veterans have been incredibly gracious about seeing that veterans of more recent conflicts get the help they feel was denied to them.  So any move that pits the two groups against each other in triaging care runs the risk of causing unnecessary friction and competition for what amounts to limited resources.  And speaking of limited resources -- although the proactive calling is in some ways a good idea (and positive PR for the frequently embattled agency) -- more and different solutions are desperately needed.  Examples include: hiring more psychotherapists, exploring treatments other than drugs and group therapy, making sure patients get seen quickly, expanding services to include outreach and education for family members, and freeing up some cash for paying private providers who are now giving their time for free, to make sure veterans get seen.  Oh, and eliminating the stigma of mental health care to career veterans, who are sometimes afraid to be seen for the impact it might have on their career advancement.  We're not even gonna mention the "shhh!!!" email here -- or the tendency to want to call PTSD by any other name including adjustment disorder -- there's enough about that in the news already.

Combat Veterans at Walter Reed Give Yoga a Try

As part of our continuing series on Complementary and Alternative Medicine (CAM) and veterans, linked here, there's news that a specific type of yoga called "Yoga Nidra" is being used at Walter Reed, bringing benefits to veterans who've been trying it.  An article from the Washington Post about the practice, by Eileen Rivers, called "A Breath of Hope: Walter Reed Tries Yoga to Counter PTSD," was published on May 6 and is linked here.  One nice quote from the article - the yoga teacher reports that "Students in class come up to me and say, 'I haven't felt this relaxed in a long time,' " "They say that they are more patient with their family. They're not as angry," she adds.  One of the participants mentioned in the article, combat veteran Derrick Farley, a 29 year old Army sergeant from Fort Bragg, who has deployed to Iraq three times, says that what he's learned in class has helped him cope.  He practices what he's learned, stays in touch with the other participants he's met in the program, and appreciates the chance yoga's given him to get a more restful night's sleep.  As he says as the conclusion of the article, " "It's not about finding a cure for PTSD," Farley said. "It's about learning to cope."  Excellent and well-said!

To learn more about Yoga Nidra, including trainings offered for practitioners and individuals on both coasts, check out the link to the Center for Timeless Being, located in Sebastopol, CA, linked here. Or you can pick up the CD by that center's director, Richard Miller, Ph.D., called Integrative Restoration: The Ancient Practice of Yoga Nidra for Easing Stress, Healing Trauma, and Awakening to Your Timeless Presence, linked here.

NYC's Urban Justice Center Offers Returning Veterans Legal Aid and Advocacy

The Veterans and Servicemembers Project of New York City's Urban Justice Center, linked here, offers, in their own words, "legal services and advocacy to a population often abandoned by the very system of government they defend in battle. Drawn increasingly from the poorest and most vulnerable communities in the country, past and present military personnel contend with poorly regulated recruiting tactics, unsafe working conditions, and an antiquated and overloaded disability benefits process. Often unaware of their rights and wary of challenging authority, they face especially daunting barriers to necessary assistance."

Furthermore, "At an individual level, the Veterans and Servicemembers Project provides legal training and representation on matters ranging from veterans disability claims to service discharge applications. The project also pursues systemic reform through litigation and advocacy in such areas as recruiting irregularities, workplace harassment, and inefficiency and abuse in the benefits application process. With the active collaboration of existing service organizations, it aims to provide comprehensive education and support for a population that, in a time of mounting war, promises only increase in size and collective need." 

Editor's Note: To learn more about this program, read the excellent article by Thomas Adcock, called, "Returning from War," originally published in the New York Law Journal, on February 22, and linked here.  If you're a lawyer who'd like to participate pro bono in helping veterans, click this link. 

Meeting Needs of Returning War Veterans, Families and Communities - Conference

The Massachusetts School of Professional Psychology has an upcoming conference scheduled on Friday, June 13th, from 2:30 pm to 5:00 pm, entitled "Returning War Veterans: Meeting Health Needs of Veterans, Families and Communities."  The program, which is the 31st Erich Lindemann memorial lecture, will feature a panel discussion, including longtime veterans advocate and VA psychiatrist, Jonathan Shay, M.D., Ph.D., winner of a MacArthur grant and the author of several important books on understanding the psychology of combat veterans: both Achilles in Vietnam: Combat Trauma and the Undoing of Character, and Odysseus in America: Combat Trauma and the Trials of Homecoming.

CE Credits:	2.5 (for Psychologists, Social Workers, Nurses & LMHCs)
Tuition:	$20.00 (for CE Credits) Open to the Professional Community and the Public, No Admission Charge. Pre-registration requested. Call 617-327-6777 x 282 to reserve your seat.
	Speakers: Jaine L. Darwin, Psy.D., Supervising Analyst, Massachusetts Institute for Psychoanalysis; Clinical Instructor in Psychology, Dept. of Psychiatry, Harvard Medical School; Co-Chair, SOFAR Project—Strategic Outreach to Families of All Reservists Richard T. Moore, M.A., State Senator and Chairman of the Health Care Financing Committee; General Court of the Commonwealth of Massachusetts Jonathan Shay, M.D., Ph.D.., Staff Psychiatrist, Veterans Administration Outpatient Clinic, Boston; Author of Achilles in Vietnam: Combat Trauma and the Undoing of Character (1994); and Odysseus in America: Combat Trauma and the Trials of Homecoming (2000); MacArthur Foundation Fellowship Award (2007) Moderator David G. Satin, M.D., DLFAPA, Assistant Clinical Professor of Psychiatry, Harvard Medical School; Chairman, Erich Lindemann Memorial Lecture Committee

The program is sponsored by The Erich Lindemann Memorial Lecture Committee, and The Erich Lindemann Community Mental Health Education Center Initiative of the Massachusetts School of Professional Psychology in cooperation with The North Suffolk Mental Health Association Board of Directors.

For further information about the program, including registration, click here. To read our previous blog entries about Dr. Shay, click here, here and here.

When PTSD Sufferers Can't Sleep, Award-Winning "Pacific Light" DVD Brings Some Healing Peace

Hyperarousal or heightened anxiety.  Flashbacks, nightmares, intrusive memories.  Intense physiological stress symptoms: pounding heart, rapid breathing, nausea, muscle tension, sweating. Difficulty falling or staying asleep.  Irritability or outbursts of anger. Difficulty concentrating. Hypervigilance, or being constantly “on guard.” An exaggerated startle response, or jumpiness. Inability to relax. All these symptoms are very familiar to PTSD sufferers and their families.

Pacific Light, Wind and Waves Healing Music DVD for Stressed and Anxious Patients.

Into this mix comes the award-winning "Pacific Light" DVD, and the elusive promise of an interlude of healing peace, that might even involve a good night's sleep.

Time, Inc. awarded Pacific Light its first place award for health and medical media.  Alternative Medicine mgazine calls Pacific Light "a breathtakingly beautiful video."  And over 400 hospitals use "Pacific Light" to help provide an atmosphere of healing peace for distressed patients and their families.  Walter Reed, the Mayo Clinic, the U.S. Army, U.S. Navy and the U.S. Marine Corps at Twentynine Palms, plus hundreds of other institutions are becoming fans of this DVD, a combination of stunning cinematography of some of the West Coast's most beautiful locales, filmed at sunrise and sunset, with no cheesy voiceover instructing patients to relax -- instead, the Grammy-nominated, award-winning soundtrack of R. Carlos Nakai's cedar flute music, as arranged by Billy Williams.

Pacific Light is the second DVD in a series by Thomas Day Oates, Jr., an amazing person and personal friend, whose own bouts with serious illness changed his career path into cinematography.  Oates has a very strong conviction about the importance of distressed patients and their families being able to create a space for "healing peace" - he believes the words are almost synonymous -- and that without a sense of peace, people can't begin to heal.

Apparently, a number of hospitals, hospices, and patients agree -- the testimonials are pretty impressive; and even without them, watching a clip of the gorgeous scenery and its peace-inducing soundtrack make the point instantly accessible.  For hospitals and institutions, click here. For individuals and families, click here. Website linked here.  Ordering info: 1-877-835-0838. Special pricing for veterans and their families: $19.98, including shipping and handling (within the U.S./APO/FPO). Call to inquire.

Editor's Note: You know who/where else needs this DVD?  Balad Military Hospital in Iraq. Landstuhl Regional Medical Center in Germany. The Combat Stress Control Unit. Mologne House Hotel in DC. Military chaplains in Iraq, Afghanistan, and stateside.  PTSD residential programs at the VA. VA Medical Centers.  Wounded warrior units.  Wounded troops, wherever they are recovering, at home and abroad.  The possibilities are practically endless.  And not just for the troops themselves: for their caregivers as well, who often are also suffering from vicarious trauma.

Music as Medicine: Sound Healing and PTSD

In our continuing series about "Complementary and Alternative Medicine" modalities that may offer potential for treating PTSD, one item that's suggested in the literature is "sound therapy."  To learn a little more about it, here's some information from some of the experts in the field, and, a few selected items for listening.

 

According to one Rodale guide, in its section about PTSD,

To ease anxiety related to post-traumatic stress syndrome, try listening to relaxing music for at least 20 to 30 minutes each day, says Steven Halpern, Ph.D., composer, researcher, and author of Sound Medicine: Music for Healing.

To get started, turn on the music, then sit or lie comfortably, close your eyes, and take a deep breath.  Dr. Halpern suggests that you wear headphones to focus your full attention and to avoid distractions.  He recommends, however, that you keep the speakers playing, so your body absorbs the sound energy.  While the music plays, let your breathing slow down and become steady.  Listen not just to the notes but also to the silence between the notes.  Dr. Halpern says this will keep you from analyzing the music, which will allow it to relax you.

(Similarly, the emphasis for listening should be on "largo".)

When it comes to relaxing music, the key is largo.  That's music played at a slow tempo, called largo, which can reduce your heart and breathing rates, calm your body, and help it heal itself, says Janalea Hoffman, R.M.T., a composer and music therapist based in Kansas City, Missouri.

Look for music that is played at 60 beats per minute or less.  Most music is faster than that and won't help slow your heartbeat, Hoffman says.  "What you are looking for is the largo section of each piece.  That's the part with a beat that works."  These composers are among those who have largo sections in many of their compositions: Johann Sebastian Bach, Antonio Vivaldi, George Frideric Handel, and Georg Phillip Telemann.  Most records, tapes and CDS list the different sections of each piece, in order, on their covers.  The problem is that these slow sections last only a few minutes. For longer listening, you will find lots of specially made tapes in music stores and can order even more from other sources.

Source: New Choices in Natural Healing: Over 1,800 of the Best Self-Help Remedies from the World of Alternative Medicine, Edited by Bill Gottlieb, Editor-in-Chief, Prevention Magazine Health Books.  Emmaus, PA: Rodale Press, Inc. (1995).

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Some well-regarded longer pieces in the sound health/sound medicine category are the following, all available at Amazon.com:

 

Inner Peace, by Steven Halpern, Ph.D.; Effortless Relaxation, by Steven Halpern, Ph.D.;  Letting Go of Stress, by Steven Halpern, Ph.D.; Tao of Peace, by Li Xiang-Ting and Dean Evenson; Sound Body, Sound Mind: Music for Healing, by Andrew Weil, M.D. and Joshua Leeds; Relax and De-Stress: Music for Self-Healing, by Andrew Weil, M.D., and Joshua Leeds; The Tao of Healing, by Li Xiang-Ting and Dean Evenson; Sound Healing, by Dean Evenson; 

 

and particularly for getting a good night's sleep, which is so essential for reducing anxiety and improving healing:

 

Sleep Soundly, by Steven Halpern, Ph.D.; The Delta Sleep System, by Dr. Jeffrey D. Thompson; 

James S. Gordon, M.D., Founder and Director of The Center for Mind-Body Medicine

James S. Gordon, MD, a Harvard-educated psychiatrist,is a world-renowned expert in using mind-body medicine to heal depression,anxiety,and psychological trauma. He is the Founder and Director of The Center for Mind-Body Medicine, a Clinical Professor in the Departments of Psychiatry and Family Medicine at Georgetown Medical School, and recently served as Chairman of the White House Commission on Complementary and Alternative Medicine Policy. He also served as the first Chair of the Program Advisory Council of the National Institutes of Health’s Office of Alternative Medicine and is a former member of the Cancer Advisory Panel on Complementary and Alternative Medicine of the NIH.

 

Dr. Gordon has devoted over 35 years to the exploration and practice of mind-body medicine. After gradating Harvard Medical School, he was for 10 years a research psychiatrist at the National Institute of Mental Health. There he developed the first national program for runaway and homeless youth, edited the first comprehensive studies of alternative and holistic medicine, directed the Special Study on Alternative Services for President Carter’s Commission on Mental Health, and created a nationwide preceptorship program for medical students.

 

Dr. Gordon has created ground-breaking programs of comprehensive mind-body healing for physicians, medical students, and other health professionals; for people with cancer, depression and other chronic illnesses; and for traumatized children and families in Bosnia, Kosovo, Israel and Gaza as well as in post-9/11 New York and post-Katrina southern Louisiana. Nearly 3,000 health and mental health professionals throughout these regions have been trained by Dr. Gordon to more effectively address the psychological trauma within their communities, including supervision and training of a local leadership group within each region which enables the CMBM model to be fully integrated into and sustainable within the local healthcare community.

 

Dr. Gordon’s most recent book is Unstuck: Your Guide to the Seven Stage Journey Out of Depression (Penguin Press). His also the author of Comprehensive Cancer Care: Integrating Alternative, Complementary and Conventional Therapies and Manifesto for a New Medicine: Your Guide to Healing Partnerships and the Wise Use of Alternative Therapies (both Perseus Books). In addition, Dr. Gordon has written or edited 9 other books, including the award-winning Health for the Whole Person, and more than 120 articles in professional journals and general magazines and newspapers, among them the American Journal of Psychiatry, Alternative Therapies in Health and Medicine, Journal of Traumatic Stress, Psychiatry, The American Family Physician, The Atlantic Monthly, The Washington Post, and The New York Times. He also helped develop and write the educational materials to supplement the public television series “Healing and the Mind with Bill Moyers”.

 

Dr. Gordon’s work has been featured on Good Morning America, The Today Show, CNN, CBS Sunday Morning, FOX News and National Public Radio, as well as in The Washington Post, USA Today, Newsweek, People, American Medical News, Clinical Psychiatry News, Town and Country, Hippocrates,  Psychology Today, Vegetarian Times, Natural Health, Health, and Prevention.

Not Specific to Combat, Research Project Studies Use of Tibetan Meditation to Treat PTSD

Although not specifically directed towards combat veterans and PTSD, a research study is currently evaluating whether Tibetan meditation has benefit for PTSD sufferers. Miami and Ohio State university researchers will use an ancient technique to address a modern problem. With a $98,000 grant from the Ohio Department of Mental Health, Deborah Akers, Miami visiting assistant professor of anthropology, will work with co-researchers from Ohio State on a project titled "Treatment of Trauma Survivors: Effects of Meditation Practice on Clients' Mental Health Outcomes."  (For more information about the department conducting the study, click here.) Akers and co-researchers Moyee Lee, professor of social work, and Amy Zaharlick, professor of anthropology, will investigate the impact of Tibetan meditation on victims of post-traumatic stress disorder (PTSD). The project began this month and will continue for two years.

Researchers will work with a group of women diagnosed with PTSD who live in Amethyst House, a women's treatment program for alcohol and drug addiction in Columbus. Tibetan monk Geshe Kalsang Damdhul of the Institute of Higher Buddhist Dialectics in Dharamsala, India, will assist as a meditation instructor. "Participants will be taught specialized meditation techniques and will be guided through meditation for a period of six weeks," said Akers. Results could then provide a new option for treating other victims of PTSD, such as combat soldiers returning from war or victims of natural disasters such as Hurricane Katrina. "This project charts new ground, bringing a holistic perspective to the treatment of PTSD," said Akers. She added that though meditation has been used in a variety of therapeutic settings in the West, such as reducing stress and coping with pain,its application in the treatment of mental illness, including PTSD, has not been extensively explored.

 

"Whereas in the West treatment of PTSD may require years of prescription medicine and counseling, the Tibetan approach has been successful within one to two years by focusing on the spiritual connection between the mind and the body that seems to allow the patient to process the trauma more effectively," said Akers. "Moreover, unlike Western medical therapies, meditation is free and can benefit individuals who cannot afford extensive therapy or medicine over long periods of time. The Tibetan approach is empowering, as it offers PTSD patients an alternative and less invasive form of therapy and enables them to participate in their own treatment." The project grew from a Miami summer field school program, "Peoples and Cultures of Tibet," conducted in Dharamsala, the residence of the spiritual leader of the Tibetans, the Dalai Lama, and location of the Tibetan government in exile. During the field school, Akers and Miami students learned about how Tibetan monks minister to political prisoners and victims of torture who suffer from PTSD. For more information about the program, click here.) Several Miami pre-med and anthropology students will assist in the Columbus project, gaining hands-on research experience.

"The PTSD research project and the summer field program in Dharamsala exemplify Miami University's continuing interest in South Asia," said Akers.

PTSD Experts - How to Find a PTSD Expert, Easily

One of the recent enhancements to this blog is the creation of an ongoing directory of PTSD experts, linked here.  These are known experts in the field of post-traumatic stress disorder (PTSD), who ideally are familiar with the ravages of combat trauma, and what it takes to heal.  This directory, which is not alphabetized, should serve as a one-stop directory for biographical information about these experts, which is of benefit to reporters, journalists, those planning conferences who need to find speakers, lawyers looking for experts to testify in court cases, etc.  If someone you think deserves inclusion isn't listed yet, it may just be that we haven't gotten a chance to post their information yet, so please feel free to submit it for possible inclusion.  Otherwise, it's guaranteed to be a continual work in progress, but already more informative than anything else that's out there -- because the information is extremely hit-or-miss on the Web -- hence the creation of this directory.  (Case in point: a U.S. government-sponsored trauma specialists directory, which shall be nameless because it was so embarrassingly bad, which listed only one(!) expert, worldwide -- seriously! why even bother? -- despite having been up for years.)

Mind-Body Medicine Conference - Includes Therapies for PTSD

A conference is planned for October 25-29th in Minneapolis, MN on Mind-Body Medicine, geared towards practitioners -- training the trainers -- around the topic, "Integrating Mind-Body Medicine into Clinical Practice, Medical Education & Trauma Healing."  The conference is sponsored by James S. Gordon, M.D.'s Center for Mind-Body Medicine in Washington, D.C.  The Harvard-trained Gordon is a luminary in the field of mind-body medicine, having authored numerous books on the subject, been featured in Bill Moyer's PBS series, Healing and the Mind, and has been a frequent speaker at the Smithsonian, in their public lecture series.  He is a clinical professor at Georgetown University School of Medicine, and is the former chairman of the White House Commission on Complementary and Alternative Medicine Policy.  The Center has done significant work with trauma in the Middle East, Kosovo, in Louisiana with victims of Hurricane Katrina, with 9/11 rescue workers, etc. 

The conference information is linked here. Dr. Gordon's bio is linked here.  The Center for Mind-Body Medicine is linked here.

Just Say "Om" - Yoga and Meditation for PTSD

Long before Mehmet Oz, M.D., was a regular guest on "Oprah" -- long before the Army started contemplating whether Complementary and Alternative Medicine had a place in treating PTSD, blogged about here -- there was yoga, and there was meditation.  For thousands of years, these techniques for helped adherents gain flexibility, quiet the mind, and often, restore some inner peace.  CAM for PTSD is in the news recently, but a book by well-regarded Rodale Press, from a dozen years ago, mentions both yoga and meditation, as well as sound healing, as possible therapies for PTSD.  Here's what they have to say:

Stress reduction is an essential part of recovery from post-traumatic stress disorder, says Stephen A. Nezezon, M.D., yoga teacher and staff physician at the Himalayan International Institute of Yoga Science and Philosophy in Honesdale, Pennsylvania.  To lower stress, he says, you can try a daily routine of breathing exercises, mediation, and yoga poses.

Do the complete Yoga breath exercise (see link here) whenever you’re feeling stressed, suggests Alice Christensen, founder and executive director of the American Yoga Association.  Meditation helps clear your mind and teaches you to relax, she says.  For the poses, select three or four from a Yoga daily routine.  Christensen recommends varying the poses daily to keep your interest high and to strengthen different parts of your body.  Dr. Nezezon says you should include at least one relaxation pose, such as "the corpse" (pictured above), "knee squeeze," or "baby," in your daily yoga routine.

Dr. Nezezon also recommends doing the "alternate nostril breath" (explanation linked here) each day as a way of helping you regain emotional balance. 

Source: New Choices in Natural Healing: Over 1,800 of the Best Self-Help Remedies from the World of Alternative Medicine, Edited by Bill Gottlieb, Editor-in-Chief, Prevention Magazine Health Books.  Emmaus, PA: Rodale Press, Inc. (1995).

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For more information about yoga, try these highly-rated instructional videos, produced by Gaiam, an excellent source for such material: Yoga for Beginners, Yoga for Stress Relief (with the Dalai Lama), and AM/PM Yoga For Beginners (with The Dalai Lama & 10 Routines),  You can also try reading about Yoga on About.com (linked here), subscribe to the Yoga Journal, or watch the Yoga Journal's video on Yoga for Stress.  (All hyperlinks lead you to the material described.)

 

For more information about meditation, sometimes referred to as "the inner Yoga," try these videos by Gaiam, an internationally-recognized source of high-quality instructional material about various bodywork therapies, including yoga.  Meditation for Beginners, and/or Relaxation and Breathing for Meditation.  You can also try books at Amazon.com by American author, Jon Kabat-Zinn, Ph.D., featured in an excellent Bill Moyers series on PBS years ago called Healing and the Mind.  Kabat-Zinn is Professor of Medicine Emeritus and founding director of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School in Worcester, Massachusetts.  Kabat-Zinn teaches mindfulness meditation as a technique to help people cope with stress, anxiety, pain and illness, and leads workshops and retreats on the power of mindfulness, such as the one linked here (registration is full, but there is a waiting list).

Army Broadens View of Possible PTSD Therapies, Includes Complementary and Alternative Medicine

A Military.com article published on May 29th reports on the U.S. Army's increasing openness to non-traditional therapies to treat PTSD.  The article by Bryant Jordan is called, "East Meets West in Army Mental Therapy," and it quotes Col. Elspeth Ritchie on the Army's increasing openness to options beyond traditional counseling and medication, to include items like yoga, acupuncture, meditation, and of course, virtual reality. The headline is positive, but in truth, the Army may be taking only baby steps towards including nontraditional therapies, often known as Complementary and Alternative Medicine (CAM).

(Some "definition of terms" is in order.  "Alternative medicine" means treatment choices other than conventional medicine, to be used instead of conventional medicine; "complementary medicine" means treatment choices to be used in addition to conventional medicine -- so the term "CAM," or "Complementary AND Alternative Medicine" is meant to be inclusive of both approaches.  This ends up being an important distinction, because responsible M.D.s are often more in favor of patients adding complementary therapies in to their treatment protocol, rather than replacing a conventional treatment protocol with fully alternative therapies. "Complementary" is misspelled in the Military.com article as "complimentary," which further confuses the terminology.) 

The article states that "Therapies that are "kind of tried and true" remain at the forefront of treating Soldiers with behavioral problems, [Col.] Ritchie said. These include behavioral therapy and exposure therapy -- where patients are "exposed" by degrees to scenarios that may be at the core of the problem -- and medication."  And it further quotes Col. Ritchie as saying that although CAM therapies "are interesting, we don't have the hard data to show which therapies are useful for what population. So we're really in the research phase of this for yoga, acupuncture and some other therapies."

The Military.com article is linked here.  A previous article by Noah Shactman in Wired magazine on March 25 discussed similar material, and mentions a Department of Defense grant opportunity with a closing date of May 15, providing $4 million in funds to study therapies with possible benefits for PTSD and/or TBI, including but not limited to "music, animal-facilitated therapy, art, dance/movement, massage therapy, EMDR program evaluation, virtual reality, acupuncture, spiritual ministry, transcendental meditation, yoga and other novel approaches."  (The grant opportunity announcement is linked here.)  According to the Wired article, reading from the grant application, the Army is willing to contemplate as well the potential effectiveness of "biologically-based treatments, botanicals, and nutritional supplements for enhancing cognitive function and mood in patients with trauma spectrum disorders, including TBI and/or PTSD, depression, anxiety, and/or substance dependence/abuse," and adds, "Even proposals for wild-sounding "therapies using bioenergies such as Qi gong, Reiki, distant healing and acupuncture" would be accepted."  The Wired article is linked here.

I'm unclear whether the Army is leading the way of all the military branches in considering the potential of CAM for PTSD; but whether it is or isn't, kudos to it for being reasonably open-minded.  One of the problems that seems to keep coming up with PTSD is that no one obvious choice comes up in treating it, that works every time.  There are a variety of pharmaceutical drugs that are prescribed, but no one remedy in particular appears to be the wonder drug, or cure-all.  (You hear the frustration about this when you listen to the stories of combat veterans who are taking a handful of pills to combat PTSD, sometimes as many as 20 or 30 separate medications - a scary cocktail, indeed.)  Other approaches for PTSD, such as talk therapy, cognitive therapy, EMDR, etc., all have their place in the pantheon of treatments, and each has their adherents/proponents, but again, there doesn't seem to be a one-size-fits-all, cure-all for PTSD.  In the absence of the medicinal "silver bullet" that cures all PTSD, it's great that the Army is at least embracing the concept of possible adjunct therapies, while asking them to prove themselves clinically, as much as possible.

In the following weeks, we will report on complementary and alternative therapies that appear to have some benefit in treating PTSD; in addition to the more mainstream approaches that are already in use.  (Virtual reality is another type of treatment entirely: dependent on technology, it doesn't fit the typical rubric of CAM, nor should it.)

Finding a Qualified Attorney to Represent You

In the coming months and years, more OIF/OEF veterans will need attorneys' help in getting disability payments they're entitled to, and representing them in the occasional criminal matter.  It's important for veterans and their families to find experienced attorneys who are knowledgeable about veterans' issues, and ideally are also compassionately disposed towards veterans and their families, and the particular struggles they might undergo, including PTSD.  We can think of several cases from the past few years, where returning veterans with PTSD committed crimes and needed representation that could effectively convey their side to a judge or jury: Daniel Cotnoir, Eric Acevedo, and, had he lived, Travis Twiggs (for the carjacking and resisting arrest in the ensuing police chase).  Thrown back on their own or their families' limited resources, veterans who have been charged with a crime may end up a) looking through the phone book or b) getting a public defender appointed by the court to represent them.  While there's nothing wrong with these approaches, they're also pretty subject to chance. What we'd like to see, over time, is a network develop of attorneys across the country who have a special expertise and concern for representing veterans in healthcare and criminal matters (not many attorneys will do both, but some undoubtedly will.)

To find a qualified attorney, consult your local state or county bar assocation's lawyer referral line, or learn how to use Martindale-Hubbell, the directory of lawyers across the United States.  "AV" is the highest rating that lawyers receive in Martindale-Hubbell, conferred by their legal peers; so finding an "AV" rated lawyer to represent you would be a best-case scenario; although the lack of this rating does not imply substandard service or qualifcations. If you choose an attorney on your own (i.e., through the phone book), be sure to also check the lawyer's background with the local bar association to see whether he or she has ever been sanctioned or disbarred in the past (better safe than sorry!).  Use this tool, provided by the American Bar Association, to find the state or local bar association in your area.

Periodically we learn of a lawyer who seems to have a special expertise or affinity for representing veterans.  When we learn of such a lawyer, we'd like to include their information here, so it will be readily available to more potential clients.  Mentioning the name here does not imply an endorsement, but is an attempt to make resources available to interested parties.  We have no way of knowing about the quality of legal representation offered.

In disability matters, we've learned about the Law Offices of Robert Franklin Howell, in Monterey, CA, linked here.  Howell is both a longtime practicing attorney, and a combat veteran. To learn about his disability law practice, click here.  To contact him directly, click here.

In criminal matters, we've learned about attorney Jim Lane, whose Fort Worth, TX firm is linked here.  Lane, who has practiced law for approximately 40 years, was a captain in the U.S. Army as well as a military JAG officer.  His specialties including personal injury, criminal defense (felonies and misdemeanors), and court martials.  To contact him directly, click here.

Just a word of wisdom here, based on common sense: when you do go to consult an attorney, make the most of both of your time by having written down the facts of your case in advance, and, as much as possible, keep your initial contact short and sweet.  Be aware that the first point of contact in many lawyers' offices is a receptionist or a legal assistant, who is not empowered to handle your case.  Do not overwhelm that person with your needs and desires, nor the attorney, when you are able to speak with him or her. Keep it to the facts, take notes on what's discussed and what the game plan is, and bring someone along with you to your first meeting, if you feel that you are likely to be too emotionally involved in your own case to listen well or take good notes.  Learn how to be a good client, and you'll go farther with a good lawyer.  Clients do occasionally wear out their attorneys or get fired by them for being too difficult, which is very unfortunate, and will not help your getting closure.  Here is a good article about how to be a good client.  It's directed to family law, but the tips it suggest apply to other areas as well. Read it and consider what it says (linked here.)