Healing Combat Trauma

Vietnam, Iraq and Afghanistan -- Suffering and Love

It's interesting to live a life that's been bracketed on either side by wars in Vietnam and now Iraq and Afghanistan. It certainly created an awareness of hardship and suffering, and the need and desire to offset that. And it brings to mind a favorite quote: "Suffering accompanies life, but love is affirmation." -- Everyday Tao, by Deng-Ming Tao.

Quotable Quotes -- True Freedom

"True freedom is the ability to pause between the stimulus and the response, and in that pause to choose."

Quotable Quotes -- Where the Expectation of Healing or Recovery Comes From

Had a short conversation the other day with a Vietnam vet, now substantially recovered from the PTSD symptoms that plagued him for four decades. (See the recent part of his story, here.) We were discussing how, in both of our situations, me with chronic fatigue syndrome, him with PTSD, how crucial it was that -- despite how things looked from time to time -- we truly did believe, somewhere inside us, that we were going to get better. We didn't know how, and mostly it looked like it wasn't ever going to happen, but each of us in our own way refused to believe that there was no help to be had. We couldn't explain it, maybe, but inside us we both knew, someday we'd find a way to get better.  And we talked about how important it was to hold on to that small kernel of hope, even when circumstances around us looked so bleak, as they often did. It reminded me of this quote, about where that hope for recovery actually comes from...it comes from somewhere deep inside us. So even when we're tempted to give up, because the life around us can seem like a nightmare, the tiny kernel of hope for a better life, and better circumstances, is our innate belief that we can get better. As the quote says:

"If what was in your dreams wasn't already inside of you, how would you even be able to dream it?" -- Kobi Yamada.

Quotable Quotes -- the Oft-Neglected Role of the Caregiver in Illness

"As little as we know of illness, we know even less of care. As much as the ill person's experience is denied, the caregiver's experience is denied more completely." -- Arthur Frank, "At the Will of the Body."

Editor's note: We have a section entitled, "Caring for the Caregivers." Click on this link to expand.

Quotable Quotes -- Ajahn Jayasaro on the Refining Power of Empathy

"In a conflict, if we are convinced we are good, right, pure and the other side is evil, wrong, impure, we have lost our way... Thinking in terms of us vs. them, white vs. black, good vs. evil, is like a disease that has caused untold suffering in the world. Empathy...does not...cripple action, but makes it more intelligent." -- Ajahn Jayasaro, from "On Love."

Yoga for Veterans is Back in the News...

Yoga classes for veterans -- offered, in many cases, free of charge, at least initially, by practitioners nationally -- is back in the news.

(For a link to previous articles about the topic, including the work being done at Walter Reed, click here.)

"Yoga Warriors" is based in Central Massachusetts, and they offer classes to veterans but also train yoga teachers to work with veterans. From their website:

"The Yoga Warriors program was established at the Central Mass Yoga and Wellness in West Boylston, MA, and has been ongoing since 2005.  Yoga Warriors programs are being established in different parts of the country.  Interested vets can contact the Central Mass Yoga and Wellness at 508-835-1176 to put their name on the contact list.  Some of the classes are free to all vets. Registered yoga teachers that wish to become certified in the Yoga Warriors method can also call the above number to register for an upcoming teacher training workshop." (For a link to their website, click here.)

Paul Zipes, based in Florida, has a  "Yoga For Vets" program that he started a few years ago. We've written about it, here, and are about to again. His program connects yoga practitioners who want to offer a limited number of free classes to veterans of combat or conflict with the veterans who want to take them. For a link to Yoga for Vets, click here.

Former Marine Anuradha Bhagwati started Yoga for Vets NYC started in July, 2008 "as a service for NYC veterans." She says, "the program is designed specifically for veterans dealing with injuries or trauma, but every veteran is welcome, regardless of age, era or experience." For a link to this program, click here.

CBS News had a short segment today called "Yoga Soothes War Vets." Watch it below:

The video shows Vietnam veterans enjoying the experience, but one Vietnam veteran I know didn't take to yoga too enthusiastically. Too many aches and pains for him to enjoy it very much, he said. However, he's a much bigger fan of Qi Gong -- which is sometimes called "the Chinese yoga." For more information about Qi Gong, also called Qigong or Chi Kung, read two recent posts on the subject: here and here. Both yoga and qi gong offer demonstrable health benefits and encourage a more relaxed, calmer mind, and lowered anxiety and tension.

More Recommendations for Qi Gong DVDs for Veterans with PTSD from PBS' Lee Holden

Following up on a post from over the weekend, I was able to find my earlier notes which list the rest of the recommendations from Qi Gong expert Lee Holden, featured on PBS. This was the list in full of what he recommended for veterans suffering from PTSD. (Read the earlier post, linked here, called "The Beneficial 'Moving Meditation' of Qi Gong," for why Qi Gong is a great stress-reduction technique.) Lee Holden's DVDs are only available through his website, and VERY occasionally, used, from Amazon.com. His website is linked here. If you order more than one DVD, look for a shipping special (current at this time) for ordering four. 

(His newest DVD, due to be released in August of 2010, is available for pre-order on Amazon.com. It's not necessarily one of his recommendations for PTSD, but if you grow to like his material, here's one more. Usually you have to order his DVDs from his site alone, but this one will also be available for Amazon, which will probably help with the distribution of it, too.) Here's the link to that DVD.

Qi Gong for Stress Relief (previously mentioned, the #1 recommendation:

Qi Gong for Upper Back and Neck Pain:

Qi Gong Flow for Beginners: ("The PBS favorite...")

Qi Gong The Flow Continues:

Understanding Post-Traumatic Stress as a Mental "Illness" without Judgment: A Sufferer Clears Things Up

Periodically we come across something great that a PTSD sufferer has written about what it's like to live that experience, not just read about it. The following post is uniquely compelling and articulate, and it's written by Joan Esnayra, Ph.D., founder of the Psychiatric Service Dog Society. Read more about Joan's organization here. But for her wonderful letter, reprinted with permission, keep on reading below:

Dear Veterans,  

Here is what I wrote in response to one of [name redacted's] posts the other day about whether or not PTSD is a mental illness.   It comes from the heart and it is offered with respect, (if not a little tough love, too).

Dear [Name Redacted],

I know that a lot of veterans are not happy hearing PTSD referred to as a mental illness.  Perhaps this is because of some latent fears about what mental illness really is.   Mental illness is quite simply abnormal brain function in the domains of speech, cognition, behavior, and/or sensory capacities.   Not all abnormal brain function is a mental illness, but all mental illnesses are characterized by abnormal brain function.  Does this make sense?

PTSD is described extensively in the DSM-IV. This is the 'Diagnostic and Statistical Manual of Mental Disorders.'   It is the bible of Psychiatry. You don't go to a podiatrist or an audiologist for PTSD treatment.  You go to a mental health professional. This is because it is a mental illness. There is no value judgment, here. It's just a fact.

I've been diagnosed for so many years that sometimes I forget how scary it was for me when I received my first mental health diagnosis at the age of 25 (Major Depression & PTSD). Having grown up with a mother who attempted suicide with some regularity throughout my childhood years, the last thing I wanted to receive was a mental health diagnosis. Voila! There it was staring me in the face. And, despite the fact that I should have been hospitalized (indeed hospitalization was offered to me), I declined the invitation, swearing to myself that I would not become my mother!  he idea of psychiatric hospitalization was absolutely frightening to me at the time.  

Since then, I have "been there, and done that". I've seen what psychiatry and neuroscience have to offer people like me (and people like you). Did you know that Bipolar Disorder is believed by some researchers to be a dysregulation of the circadian rhythm circuitry of the brain? Where is the mental illness in that?   How can a genetic malfunction of the brain's day/night &  sleep/wake cycle cause people to suicide to the tune of 25%? To say that something is a mental illness, is not personal.  There is no value judgment in the statement. It is just the category of pathology that each of these mental disorders falls under.   It is logical and nothing else.

One of the things that veterans with PTSD have to reckon with is that they do have a mental illness. For some of you, this is a no-brainer, no big deal, like "Duh, that's pretty obvious, Joan." For others, especially the newly diagnosed, this prospect is exceedingly frightening. Allow me to proffer that the fear is not in the classification, rather, it is in our own assumptions about mental illness. When I give public presentations on PSD, sometimes people assume that I am a non-mentally ill psychologist, because I come across professionally, and because I know my subject matter, and I'm articulate. I couldn't possibly be a knife-wielding psycho, right?  I mean, isn't that what mentally ill people are really like?

Of course not!  Mentally ill people are as diverse as any other group of people. You have the high functioning, the low functioning, the assertive self-starter entrepreneurial types, and the passive, quiet, stay at home types.  The whole gamut of humanity is represented on the spectrum of mental illness. There is no "type" among those who live with mental illnesses. As a result, there is no judgment, either. 

The mental health consumer community has been pioneering PSD for 13 years.   We have an intervention that the veterans community wants and needs.  Thus, we need to be building bridges to communication so that we can benefit one another over the long term. Disparaging the characteristics of persons living with mental illness is not going to get us there. So, I'm asking you to re-think your assumptions about mental illnesses and the people who live with them.  

Someone in this group recently disparaged others' talk of suicidal ideation and self-injury. This is incredibly disrespectful to our community members.  Unless you have walked a mile in someone else's moccasins, it is inappropriate to disparage a legitimate feature of their disability. To do so is tantamount to making fun of someone who wears a colostomy bag.  "Hey Poopy Boy, You Stink!" That would be terribly rude. Don't you think?

One of the assumptions that people who are not comfortable with the concept of mental illness make is that people with mental illnesses are victims. This strikes our community as a completely bizarre attribution. What is a victim? Ostensibly, it is someone who, through no fault of their own, is harmed, used, or taken advantage by some force that is more powerful than they are. Using this definition, one might conclude that persons living with mental illnesses are indeed victims to the same extent that anyone is a victim,...of their own genetics!

But, there is another way of using the term 'victim' that disparages the sufferer. In this instance, there is implicit judgment that the person is weak, cowardly, ineffectual, and quite frankly, worthless in the eyes of society.This is the version of 'victim' that I was responding to when I read the term in your previous post. It offended me. I am not weak or cowardly or ineffectual, or worthless, and I AM mentally ill. I have no shame about saying to the world, "I live with mental illness". If I did have a problem with this, then, it would be more so a problem of self-acceptance. The fact is, I am mentally ill. Underestimate my abilities and I will prove you wrong.   Call me mentally ill, and I will agree with you.   Do you see the challenge, here, to familiar assumptions?

The veterans community needs the PSD community, and the PSD community needs the veterans community. We are like newly reunited cousins.  My side of the tracks has never gained societal acceptance because we could never hide the fact that we live with mental illnesses.  (We've been symptomatic our entire lives). Your side of the tracks has experienced societal acceptance in your role as non-mentally ill soldiers. Importantly, your side of the tracks (your peer group) has accepted you on the condition that you are not mentally ill.   

Well, guess what? Living with PTSD means that you ARE mentally ill.  So, do you go into the proverbial closet (a lot of people do), or, do you establish a separatist agenda ("we are not like those people"), or are you going to challenge society's fundamental assumptions about mental illnesses?  It is my sincere hope that you will choose the more enlightened path and look for ways to challenge societal assumptions about persons living with mental illnesses with an eye towards growing a more equitable society for all of us.

Joan

Dissociations, Flashbacks and Hallucinations: A Veteran with PTSD and MST Clears up the Differences with Examples from Her Own Life

An Iraq woman veteran friend of mine, who suffers from PTSD and MST but overcomes daily, with a delightful psychiatric service dog at her side, wrote an excellent post that I asked her permission to quote in full here. Angela was writing to this other woman, attempting to clarify, from an educated sufferer's point of view, what the differences are between dissociations, flashbacks and hallucinations, from someone who's experienced them all. At the end of the post, you can see her motivation for why she writes, and it's great. While the academic purists out there may scoff at her quoting Wikipedia for the definitions of the terms, the best part of the post is what she does with it when she compares the dictionary definition to her own experience. For someone who's not yet a college graduate, I think she did a wonderful job of expressing her understanding of the terms. It could be quite enlightening for others to read as well. Here it is, in full.

"Clearing up the differences among disassociations, flashbacks, hallucinations:

I think you are using the word "hallucination" in a broad sense of the word.

 A flashback is A LOT different from a hallucination and a dissociative episode is a lot different from both also. Here are the Wikipedia definitions and then I will go into my own personal experience with the broad world of hallucinations/ illusions/ dissociation/ flashbacks. ....so you have some concrete examples. I have had all of them at one time or another. And I am a vet w/PTSD with both sexual trauma and Combat PTSD. 

 1. Flashbacks are the “personal experiences that pop into your awareness, without any conscious, premeditated attempt to search and retrieve this memory” These experiences occasionally have little to no relation to the situation at hand. Flashbacks to those suffering post-traumatic stress disorder can be so disruptive as to seriously affect day-to-day living. 

My experience with flashbacks: driving on the highway and a hospital helicopter suddenly flies over me and lands on the hospital on the side of the highway. All of a sudden the biology in my brain, retrieves old memories. All of a sudden, I feel as if I am in a convoy in baghdad, my body feels hot as if I am back in 130 degree weather, I can smell diesel fuel from the hummer engine. My adrenaline races, my breathing quickens, my whole body acts as if I am back there again. I do not "see" things, which would be a classic hallucination it is a feeling, an old body memory.

2. Dissociation is a partial or complete disruption of the normal integration of a person’s conscious or psychological functioning. Dissociation is a mental process that severs a connection to a person's thoughts, memories, feelings, actions, or sense of identity. Dissociation can be a response to trauma or drugs and perhaps allows the mind to distance itself from experiences that are too much for the psyche to process at that time. Dissociative disruptions can affect any aspect of a person’s functioning. Although some dissociative disruptions involve amnesia, the vast majority of dissociative events do not. Since dissociations are normally unanticipated, they are typically experienced as startling, autonomous intrusions into the person's usual ways of responding or functioning. Due to their unexpected and largely inexplicable nature, they tend to be quite unsettling. Different dissociative disorders have different relationships to stress and trauma. Dissociative amnesia and fugue states are often triggered by life stresses that fall far short of trauma. Depersonalization disorder is sometimes triggered by trauma, but may be preceded only by stress, psychoactive substances, or no identifiable stress at all.

My experience with dissociation episodes:
First time it happened was in the throws of a sexual assault. All of a sudden It was like I came out of my body and was across the room watching the whole thing happen in front of me. Kind of like an out-of-body experience. Since then, I can get them once in a while when I am triggered (in my therapists' office for example) I am overcome with emotions or bad memories and they hit all of a sudden and it is as if my nervous system and brain cannot handle the flood all at once. I disconnect and it's like I can't move, can't talk, nothing, just frozen in time. My SD has learned by constant positive reinforcement and picking up on my energy because of our bond. He knows my normal state so when something NOT NORMAL happens, it's obvious he would pick up on it. He will race to me, "lap up"pr nudge me with his nose in the thigh or sometimes he even slaps me with his paw. This is just enough tactile stimulation for me to realize i am "not here" and it is proven in psychology that grounding yourself with a physical object kind of snaps you out of the dissociation.

Definition of grounding. "Grounding is a particular type of coping strategy that is designed to "ground" you in or immediately connect you with the present moment. Grounding is often used as a way of coping with flashbacks or dissociation. In this way, grounding can be considered a variant of mindfulness. Grounding techniques often use the five senses (sound, touch, smell, taste, and sight) to immediately connect people with the here and now. For example, listening to loud music, holding onto a piece of ice, or biting into a lemon are all grounding techniques that produce sensations that are difficult to ignore, thereby directly and instantaneously connecting you with the present moment." 

3. Hallucination: A hallucination, in the broadest sense, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid, substantial, and located in external objective space. The latter definition distinguishes hallucinations from the related phenomena of dreaming, which does not involve wakefulness; illusion, which involves distorted or misinterpreted real perception; imagery, which does not mimic real perception and is under voluntary control; and pseudohallucination , which does not mimic real perception, but is not under voluntary control. Hallucinations also differ from "delusional perceptions" , in which a correctly sensed and interpreted genuine perception is given some additional (and typically bizarre) significance.
Hallucinations can occur in any sensory modality — visual, auditory, olfactory, gustatory, tactile, proprioceptive, equilibrioceptive, nociceptive, thermoceptive and chronoceptive. 

A mild form of hallucination is known as a disturbance, and can occur in any of the senses above. These may be things like seeing movement in peripheral vision, or hearing faint noises and/or voices. Auditory hallucinations are very common in schizophrenia of the paranoid type. They may be benevolent (telling the patient good things about himself) or malicious, cursing the patient etc. Auditory hallucinations of the malicious type are frequently heard like people talking about the patient behind his back. Like auditory hallucinations, the source of their visual counterpart can also be behind the patient's back. Their visual counterpart is the feeling of being looked-stared at, usually with malicious intent. Not infrequently, auditory hallucinations and their visual counterpart are experienced by the patient together. Hypnagogic hallucinations and hypnopompic hallucinations are considered normal phenomena. Hypnagogic hallucinations can occur as one is falling asleep and hypnopompic hallucinations occur when one is waking up. Hallucinations can also be associated with drug or alcohol use (particularly deliriants), sleep deprivation, psychosis, neurological disorders, and delirium tremens. 

My experience with hallucinations.:

The only time I have EVER had a hallucination is when I was coming off many different medications all at once in a psych ward. I was seeing faces in the wood-grained door and seeing people that were not there. I want to stress the difference here, because seeing something or hearing something that isn't there is not the same as recalling a memory. That is the difference that is most important.

Sorry for the long-winded post, but I really wanted to clarify since you are an SD trainer working with vets who often feel misunderstood by MOST people. Saying that vets "hallucinate" is not entirely accurate and I feel that it might add to the stigma that we are just crazy lunatics, when PTSD is actually a stress injury to the brain, nervous system and physiology more than it is a MENTAL ILLNESS. It is a normal reaction to an abnormal set of circumstances."

Sincerely,  

Angela Peacock and GI Joe, PSD, CGC, Iraq Veteran, US Army

Quotable Quotes -- On Reaching the Actual Breaking Point, Where Change Happens

"People come to the consulting room and lay out a collision of values with great embarrassment and agony. They want resolution but would have something even greater if they could ask for the consciousness to bear the paradox. A friend went for her hour with Dr. Meyer in Zurich who was famous for commenting with the single word 'ja' to anything he was told. In good English style my friend bravely laid out the complexity of her life. She burst into tears and cried out that she could stand it no longer. 'Ja, gut,' replied Dr. Meyer. "Now something will happen." This is stark medicine but it is correct for one who has the strength to bear it." -- Robert A. Johnson, Jungian analyst and author of "Owning Your Own Shadow: Understanding the Dark Side of the Psyche."

The Beneficial "Moving Meditation" of Qi Gong

When April Fool's Day rolled around, one world-famous T'ai Chi teacher had this as his status update: "April 24th is 'World T'ai Chi and Qi Gong Day. (It is, by the way.) Brazil has declared it a national holiday, Utah has recognized it, and [name of giant pharmaceutical company] has filed a preliminary injunction against it."

(Anyone who's ever observed the battle between Western medicine and Complementary and Alternative medicine or "CAM" would get that joke... We've come to expect peace of mind in a pill, not in a lifestyle practice or an exercise that can reduce stress and improve immunity.)

T'ai Chi and Qi Gong are both ancient Chinese practices. T'ai Chi is more correctly a type of martial arts, and Qi Gong is often termed "a moving meditation." "Qi" is the word for what the Chinese see as the "life-force energy." This same Qi (or Chi) is what acupuncture moves along energy meridians. Qi Gong is one of several practices, including T'ai Chi and Yoga, that are effective at relaxing "body, mind and spirit." Unlike the other two, however, Qi Gong is less demanding physically, so can be done by a broader range of people, including seniors and the disabled.

In "The Complete Illustrated Guide to Chinese Medicine," Tom Williams, Ph.D., writes about these arts, "In many ways Qi Gong and T'ai Chi represent the paradox that is central to the whole way of thinking in Chinese medicine. These practices are so gentle and apparently effortless, yet they are in fact inordinately powerful and bring tremendous benefit to anyone who adopts them as part of a regular healthcare strategy."

As the Wall Street Journal reported last year, "Alternative medicine is mainstream. The evidence is mounting that diet and lifestyle (including practices such as Qi Gong, T'ai Chi and Yoga) are the best cures for the worst afflictions."

There's much to be said on behalf of this multi-thousand-year-old practice, which 100 million Chinese who practice it daily in parks, both morning and evening. It's a low-cost "health care system" that's available to all. Unlike the more rigorous T'ai Chi, Qi Gong can be done standing, or even sitting in a chair. It can be learned in a class, or at home with a DVD. There is a selection of DVDs likely to be found at your local library; and online at Amazon.com, at Gaiam.com, and at ExerciseToHeal.com. 

Lee Holden, who had a show on PBS about Qi Gong, talks about how Qi Gong leaves you "relaxed, balanced and energized." When I asked Holden which of his dozen or more DVDs he would suggest for people struggling with PTSD, he recommended "Stress Relief Qi Gong," among others. (His DVDs are available on his website, linked here.) 

Why would Qi Gong practice be particularly beneficial for veterans with PTSD? Holden clarifies:

"Qi Gong switches the nervous system from the stress related ‘fight or flight’ mode to the restorative healing mode of the parasympathetic branch. EEG shows that, in people practicing Qi Gong, the cerebral cortex enters a state of calm that few people experience, even in sleep."

(Holden is also the author of "Seven Minutes of Magic: Recharge Your Body Each Day with Qi Gong," linked here.)

Here's a sample from that DVD:

Aspects of Qi Gong, especially its less rigorous nature, combined with its health benefits, including stress reduction, make it a good fit for veterans. Leading a Vietnam combat veteran through some a Qi Gong routine, as we both followed along with a Lee Holden DVD, I asked him how he felt afterwards: "Great!" was his response. He had tried T'ai Chi, but found that he and other vets could not adapt quickly enough to it.

In my own battle with chronic fatigue syndrome years ago, after trying the best of Western and Eastern medicine, I found that it was T'ai Chi and Qi Gong that "built energy" and "moved energy" that allowed me finally to recover.I had the good fortune to take instruction in person from a wonderful instructor who adapted her instruction to even those in chronic pain, and I remember that we could do the Qi Gong exercises sitting down, and yet still experience the benefits. If you're in the Seattle, Wash. area and you can go in person to a class, I recommend Kim Ivy at Embrace the Moon, because I know her work. But if you have to get your instruction from a DVD, Lee Holden and Francisco Garripoli are highly recommended.

For more information about Qi Gong and its health benefits, there's one website in particular that's a treasure trove of information: the Qigong Institute, and it's linked here. I would also suggest reading what Lee Holden has written about it, linked here.

(Note that you may find Qi Gong spelled several different ways, including "Qigong" and "Chi Kung.")

Finally, here are two informational videos that describe a little bit more about what Qi Gong is and what the experience of practicing it is like:

and

Quotable Quotes -- Jung on the Crucible of Personal Change

"Find out what a person fears most and that is where he will develop next." -- Carl Jung, Swiss psychiatrist and the father of analytical psychology. (1875-1961) 

The Spouse's Point of View: "I Just Want It Over With, and Buried..."

Watched a great documentary last night, one hour long, originally broadcast on "The History Channel." The documentary was "Vietnam: Homecoming," and I rented it on Netflix, in their instantly-playable section. They describe it in the following manner:

"This moving documentary follows Pervis Crowe, Stanley Parker, John Hedrick and Mike Cook -- who suffer from post-traumatic stress disorder -- as they prepare to attend Operation Homecoming, a gathering in Branson, Mo., to help Vietnam veterans mend. Through poignant interviews, these anguished men share their personal stories of the pain and torment that scarred their psyches and forever changed their lives."

Good stuff. Because I've been privileged to have two years of in-depth, daily conversations with one suffering Vietnam vet, as well as having read his life story, mostly focusing around combat in Vietnam and its aftermath in his life as PTSD, which he sent me two years ago this week, I was astounded by the compelling similarities in what I heard on the screen with what I knew in real life.

Every veteran shared something meaningful. In the conversation illustrated above, a Vietnam vet and his wife exhibited typical conflict over, "you were only there for such a short time...how is it that you can't get over it yet?" frustration. As the wife said, pointedly,

"As your spouse, I don't want you to have to relive it. I want it buried. I just want it over with, and buried."

Unfortunately, that's not likely to be the case. She had "stuck by her man," -- whereas most of the wives in the documentary had not -- and yet, there were tremendous issues. In a suicide note this veteran had left, ironically with his combat brothers, he had mentioned how not only was he expecting to die, but also his wife and their daughter -- a fact that troubled his family members, not unexpectedly, quite a bit when they learned what he had said.

Another veteran, a black soldier, talked about how he managed to keep PTSD at bay until his daughter went off to college. Then his inborn conditioning that "if you get close to someone, they die" kicked in, and he became unrealistically fearful for her safety. At 50 years old, he checked in with what the VA had to offer, the first time he'd realized what an impact PTSD had made on his life, despite the decades of being afraid to get close to people or show his emotion.

Another Vietnam veteran, Marine, sat on his single bed in what looked like a hotel room, and grabbed his shaving kit of medications. This vet's "backstory" was that he was an entrepreneur, a businessman who created a company from scratch that went on to be worth millions. As he described it, he went from rags to riches, and then suddenly at age 50, he couldn't handle it anymore. The empire he built came crashing down, because his PTSD kicked in, and he couldn't run from it, couldn't keep it at bay anymore. And now he was single, marriage destroyed, dependent on pharmaceutical medications to keep his anxiety and sleepness at bay. As he sat on the bed, he took out large pill bottle after large pill bottle, filled with prescription medications, and described his dependence on each one, to help him sleep and help him cope.

I remember the second time I met with the Vietnam vet, Marine, who sought me out for help. He gave me his single-spaced, typewritten list of medications that he was on, 58 in a day, and I almost fainted. Some of them were just for the side-effects of other medications he was on! I was horrified, and sobered. No wonder he had an upset stomach all the time...

A year later, he was down to eight medications from the original 58. Gone was the pain patch, the Oxycodone, the night sweats, the nightmares, the muffled screams, the crappy sleep. Progress is possible. But it started, ironically, with listening to what the veteran went through. "No one wants to hear my story," he said. "They think I should be over it by now. I was only there for two years," he said, "they can't understand why it's the dominant experience in m life, and they're bored with it. Why can't I just move on?"

I heard echoes of that last night in the documentary, with the wife's question: "Why can't this just be buried?" I don't know if I have the stature to comment on this, but this is what I'd say. Honestly, he's not the same person you thought he was. War changed him; combat changed him. And if you can't accept that...you can't accept HIM. He's different now. And whether and how he chooses to show that, it's affected him to the core of his being. He can get better, and he can "improve," and be happier and healthier, by all external metrics...but seriously, if you don't value the core of what he experienced, and why it changed him...you are missing something very, very important. It's key to who he is. And if you wanted someone who wasn't affected by combat, well, that's not who you have right in front of you. It permanently expanded, and blew out, the boundaries of who you knew, and changed him into who he IS. And that is the veteran you can embrace, or not. The choice is yours. The experience was his (or hers). And he (or she) can share it with you, to the extent that you're open to accepting it. Be open. Work on it, if you're not. The payoff is immense. Because you will KNOW who the other person really IS.

The Healing Space between Inspiration and Destruction

As the last quote I'd like to introduce from Robert Johson, the Jungian analyst, for now, it's a passage about a type of altar seen among "primitive" peoples in Peru, who often carry this altar with them, the better to address spirituality wherever they are. I've made a botch-up of the illustration, because I wasn't able to find a "perfect" representation of the mesa, so it's a combination of several that I saw. Here is Johnson's quote. Once again, it's part of the ongoing "conversation" we're having, about whether one side has to "win out" in our natures in order to heal. Johnson and the curanderos of South America would seem to say, "no." Healing is what takes place in the space between...

 "A particularly powerful form of (overlap between darkness and light, or the self and its shadow side) can be seen in the customs of South American curanderos, who are a curious mixture of primitive shaman and Catholic priest. Their mesa (table) is an altar where they say Mass for the healing of their patients. They divide this altar into three distinct sections. The right is made up of inspiring elements such as a statue of a saint, a flower, a magic talisman; the left contains very dark and forbidding elements such as weapons, knives or other instruments of destruction. The space between these two opposing elements is a place of healing. The message is unmistakable: our own healing proceeds from that overlap of what we call good and evil, light and dark. It is not that the light element alone does the healing; the place where light and dark begin to touch is where miracles arise." -- Robert A. Johnson, Jungian analyst, author of "Owning Your Own Shadow: Understanding the Dark Side of the Psyche."

For more on the topic of the "Tao of Healing," click here. It's a selection of quotes that represents the ongoing, organic process that we undergo whenever we want to get well.

Editor's note: For more on the curanderos and their mesas, click here or here.

Quotable Quotes -- Thomas Moore on the Importance of Individuality in Healing

"To keep your soul in the medical world, preserve your individuality." -- Thomas Moore, author of "The Care of the Soul," etc.

Quotable Quotes -- Suffering Confusion in Order to Heal

"To suffer one's confusion is the first step in healing." -- Robert A. Johnson, Jungian analyst, author of "Owning Your Own Shadow: Understanding the Dark Side of the Psyche."

Finding Your Own Personal "Gold" in the Crucible of Hardship and Illness

We've talked a lot on the site for the last four years about integration as a "path" for fuller healing, and lately we've been posting what we hope you've found to be some thought-provoking quotes about what healing is and isn't. (You can find the whole set under either "Quotable Quotes" or under the "Tao of Healing" hyperlink.)

One thing we haven't explored explicitly, though now would seem to be the time to, is the purpose that tremendous suffering can have in our lives, which can be to clarify and move us towards what can actually become our lives' work. Strange that there would be any awesome takeaway from massive suffering, but it sometimes seems to be the case.

I have been reading the "Owning Your Own Shadow: Understanding the Dark Side of the Psyche" book by Jungian analyst Robert A. Johnson lately -- see yesterday's quote for an indication of some of the themes he covers. But mulling over Johnson's work, which includes the idea that a bout with tremendous suffering or illness can "break open" (almost like a nutshell) the self to something major within, like remarkable personal progress and understanding, that might not have come about any other way, I was struck today when I read the obituary of an older woman who had just passed away. It described her early life in fairly familiar terms -- schooling, marriage, family, job -- and then it mentioned that she suffered a serious illness -- and after she recovered, it went on to say, she became a talented painter, and her work was shown all over the world.

And it reminded me of how much this fit in with what Johnson was saying, how her capacity for whatever -- personal growth? artistic expression? broadening her impact on the world at large? -- was somehow connected to an initially very destructive episode -- her own brush with death.

I know I've experienced this in my personal life. A five-year struggle with chronic fatigue syndrome years ago, followed by a complete recovery -- turned my attention to things I might never have noticed before, including my now-present passion and compassion for post-traumatic stress disorder and veterans who suffer from it. Without my life-opening, life-breaking illness, and personal transformation through suffering, would I have either noticed or cared? Perhaps. But certainly not in the breadth or to the depth that I do now. Through illness, so to speak, I found my calling. How odd. But when it's your life and you look back on it, also how very true.

The Bible talks about how we learn compassion through our suffering, and because of that, can extend our compassion to others (2 Cor. 1). At the same time, it talks about affliction (which can be illness or suffering) as a "furnace," which tests us and refines who we are (Isaiah 48:10). Whether we look at those passages as religious literature or just plain wisdom, they seem to ring true.

And then we go back to Johnson, who makes it even more explicit:

"Some people may suffer a severe shock or illness before they learn to let the gold out. Indeed, this kind of intense experience may be necessary to show us that an important part of us is lying dormant or unused. In tribal cultures, shamans or healers often experience an illness that gives them the insight they need to heal themselves and then bring wisdom to their people. This is often the case for us today. We are still operating with the archetype of the wounded healer who has learned to cure himself and find the gold in his experience." -- Robert A. Johnson, "Owning Your Own Shadow: Understanding the Dark Side of the Psyche."

Editor's note: The illustration is of a crucible for melting gold. Impurities rise to the surface and are burnt right off, floating away into the atmosphere. If you've never seen it in real life, it's a powerful visual.

Demons on the Battlefield, or, Integrating the Warrior Within

Back in the fall of 2005, I had a conversation with a Marine officer in Ramadi, when Ramadi was an extremely violent place. The officer was on his third or fourth tour, and confided that he thought he'd come back to Iraq "to lay my demons down on the battlefield." Not sure what he meant by that, I suggested that more likely the opposite was true. People picked up demons on the battlefield (e.g., post-traumatic stress) but were rarely able to lay them down. If they could, more people would probably want to go to war.

In any case, as our conversation progressed over the ensuing months, I strongly preached the "gospel" of integration: something I'd learned from my own excursion into Taoist acupuncture and Chinese medicine in general. The concept of embracing opposites within us, and not rejecting one side of ourselves while embracing the other; recognizing that the good and the bad are both equally "us." It's an abstract concept, and until there's a reason to face it head-on, perhaps we never really do. Post-traumatic stress is of course one great reason to face it. We're both the angels we were before combat and the demons we found ourselves being during combat.

Many a Marine and soldier has expressed their observation about being two people. The Marines even have a saying about it, how they know how to be "the best friend and the worst enemy." The yin and the yang, the dark and the light, both dwell within. Part of the exasperating hardship of PTSD is coming to terms with how this can even be true, and yet, not destroy you. Churches and sometimes even well-meaning friends and family members insist that you can only be one or the other: the good or the bad, and if you're conflicted, well, you must just need to "pray about it harder," or, "try not to think about it so much." In fact, while balancing two selves may seem quite precarious -- the ideal self and who you've actually become -- the reality is, synthesizing the two into the "non-dual" self may ultimately be a healthier expression and resolution of the conflict within.

With this as a background, it was with interest that I read the following passage in a short but powerful book by a Jungian psychoanalyst who wrote, addressing the intrinsic conflict in warriors,

"Medieval heroes had to slay their dragons; modern heroes have to take their dragons back home and integrate them with their personality." -- Robert A. Johnson, "Owning Your Own Shadow: Understanding the Dark Side of the Psyche." 

Occupational Therapy and PTSD -- It Had Its Origins in WWI, with Shell Shock

April is "Occupational Therapy" month, and come to find out -- Occupational Therapy has an interesting past! It was founded in World War I as a way to deal with shell shock -- what PTSD was called at the time -- because it was thought that "doing" was therapeutic for injured veterans, not just "talking." I've been fascinated with this ever since I learned it from an OT with a specialty in mental health, who has practiced in and around the military for decades.

(If you know any veterans who have been injured, you've probably heard about occupational therapy for traumatic brain injuries (TBIs), amputations from IED blasts, etc. But PTSD? Wow. Who knew that it was founded as a discipline to address that!

On the hunt for more information about this topic, I uncovered the following. Carolyn M. Baum, Ph.D., the immediate past president of the American Occupational Therapy Association ("AOTA") presented testimony on post-traumatic stress disorder to the House Veterans’ Affairs Subcommittee on Health on April 1, 2008. Her testimony, "Post-traumatic Stress Disorder (PTSD) Treatment and Research: Moving Toward Recovery, "explained the unique contributions of occupational therapy in the treatment of PTSD and other mental health issues."

"Occupational therapy brings a third dimension to the system of care for PTSD. Medication and counseling, supported by occupational therapy and performance, is the approach that we recommend the VA adopt, she said."

Dr. Baum also promoted the role of occupational therapy broadly with the Veteran's Administration (VA).

(Inquiring minds want to know what happened with that...)

Here are her remarks in full:

Statements of Carolyn M. Baum, Ph.D., OTR/L, FAOTA, Immediate Past President, American Occupational Therapy Association, and Professor, Occupational Therapy and Neurology, Elias Mitchell Director of the Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO; David Matchar, M.D., Member, Committee on Treatment of Post-Traumatic Stress Disorder, Board on Population Health and Public Health Practice, Institute o Medicine, the National Academies, and Director and Professor of Medicine, Center for Clinical Health Policy Research, Duke University Medical Center, Durham, NC; and Mark D. Wiederhold, M.D., Ph.D., FACP, President, Virtual Reality Medical Center, San Diego, CA; Accompanied by Gerald M. Haase, M.D., Founder and Chief Medical Officer, Premier Micronutrient Corporation, Nashville, TN.

Statement of Carolyn M. Baun, Ph.D., OTR/L, FAOTA:

Dr. Baum. Thank you, Mr. Chairman, Members of the Subcommittee, for giving me the opportunity on behalf of the American Occupational Therapy Association to discuss issues regarding post traumatic stress disorders.

You introduced me, so I will bypass that. I also am the Professor of both Occupational Therapy and Neurology at Washington University School of Medicine.

Occupational Therapy (OT) has had a rich history providing services to veterans dating back to World War I. Occupational therapists help wounded warriors return to their military responsibilities or transition into civilian life. We do this by helping them set goals, develop strategies to accomplish their goals, and gain the skills that allow them to achieve the maximum level of participation and independence.Occupational therapy perhaps is best known for its work in rehabilitation services after stroke, loss of vision, physical injury, including amputations, and traumatic brain injury, but occupational therapists also treat individuals with stress-related disorders that result in mental and cognitive impairments as well.

OT plays a unique role in helping veterans recover from PTSD as they serve as key members of the team, that along with physicians and psychologists who use medication and counseling, the occupational therapist employs performance strategies that support the veterans in achieving success in their performance in daily activities.

Actually, it is in these daily activities that it is possible to observe the problems veterans are having with multi-tasking, with sequencing of tasks, with their safety, with their judgment, and actually identifying the cognitive fatigue which has a very important need for consideration.

These are all problems that require strategies for individuals to overcome.

The effective treatment of PTSD and the return of veterans back into their work, their family, and community lives really requires an integrated system of care that includes assessment, goal setting, treatment, and learning to self-manage life with PTSD.

Rehabilitation does not stop when veterans are discharged from hospitals or medical care. It must be provided along a continuum addressing community reintegration, social reconnections, and work accommodations. All these are areas in which occupational therapists play an important role.

Veterans with PTSD often have difficulty in their daily lives and avoid activities because they result in anxiety or fear or even anger. Consider, for example, a soldier who is driving on routine patrol when a road-side bomb explodes. Upon returning home, the veteran might experience flashbacks of that event triggered simply by driving.

The therapist might use simulated or virtual reality driving experiences or even actual driving experience in a controlled environment to help the veteran extinguish or reframe the negative stress reactions.

Therapists also work with veterans to help them manage issues related to PTSD such as depression, mild head injury, or concussion, and substance abuse by helping them develop strategies to reengage in daily life that are meaningful for them and their families. Having the families involved is particularly important because we know the importance of social support to individuals recovering from PTSD.

The unique contribution of occupational therapy is highly valued by the Army for their combat stress control. The Army model deserves additional attention from the Veterans Administration and the Subcommittee because it fully recognizes occupational therapy's contribution as a member of the team by adding the performance component to the medication and counseling provided by other team members. We recommend the VA consider and adopt the Army model.

The Veterans Administration has made significant strides in preparing to meet the needs of veterans, but work remains to be done. There are only 750 occupational therapists in the entire VA system. While both the Veterans Administration and the Department of Defense guidelines for PTSD exist and include occupational therapy, it is the experience of our members that the inclusion of occupational therapist varies from site to site. This variation does not ensure full access to effective treatment.

The American Occupational Therapy Association encourages the Committee to look at this issue. From the consultation with AOTA's members within the VA, we have heard that they are struggling to maintain the quality of care for which they are known because of increased demand for rehabilitation services and gaps in staffing.

The most important issue is to ensure that veterans receive the services they need to recover and reenter community life, able to care for themselves and others, able to work and make contributions to their families and communities. If the VA has staffing problems, they should look for, and contract with, community programs to provide the services that the veterans need.

Just as you discussed earlier with Colonel Hoge, there is also a need to study the effectiveness of complex interventions, medications, counseling, and I would ask for consideration to add the third leg to the stool, the importance of daily life performance.

Research should seek to understand the relationship of quality of life to PTSD symptom severity, disability, treatment outcomes and cost. The problem begs for an interdisciplinary translational clinical study.

Mr. Chairman, I have made additional recommendations in my written testimony, but I want to highlight a couple of issues for your Subcommittee's consideration.

To increase the numbers of occupational therapists within the Veterans Administration, we would urge that the Subcommittee consider expanding the Student Loan Repayment Program to ensure that the VA remains an attractive employment option because there is a real supply and demand issue for OTs right now and that would draw people to the VA services.

Salaries in the VA appear to be lower than other healthcare settings. The Bureau of Labor Statistics estimated in 2006 that the average salary in California for occupational therapists was $73,000. Right now the Palo Alto Polytrauma Rehab Center is offering $50,000 for two new positions that have been vacant since last July.

New positions continue to be added across the country, but salary will continue to be an issue, and AOTA urges the Subcommittee and the VA to attend to salary, recruitment, and retention issues.

Mr. Chairman, in conclusion, I want to reiterate that occupational therapy has expertise in the treatment of functional impairments resulting from a broad range of conditions faced by veterans, including PTSD. Occupational therapy should be explicitly included on treatment teams to address the every-day life issues of veterans and their families through the phases of recovery and community reintegration.

Thank you very much for the opportunity to provide testimony to the Subcommittee. AOTA looks forward to working with Congress and the VA to meet the needs of our veterans. And I would be happy to answer any questions. Thank you.

[The prepared statement of Dr. Baum appears on p. 45.]

Mr. Michaud. Thank you very much, Dr. Baum.

Editor's note: The source for the testimony is linked, here.

Quotable Quotes -- Marcel Proust on the Life Journey That Brings Wisdom

"We don't receive wisdom; we must discover it for ourselves after a journey that no one can take for us or spare us." -- Marcel Proust, French writer and essayist, 1871-1922.

Quotable Quotes -- War Provides the Enemy Within

"A Jewish chaplain once told me that in war, you face two enemies. The easy one is the enemy, but the hard one is the one within — because it can bring out the worst in people. But it can also bring out the best in people." -- Lt. Col. John Fenzel, III. "USA: The Human Dimension of Human Rights," delivered at the "Ethical Dilemmas for Special Forces Workshop," June 11-12, 2003 Ft. Bragg, NC.

(Fenzel is also the author of "The Lazarus Covenant.")

A Veteran's Journey from Suffering and Despair to a "Happy and Productive Life..."

Had this conversation just now with a Vietnam combat veteran, who struggled for decades with severe and chronic PTSD. (Read about him in the "Eyewitness to Combat" section. It's gripping...)

It's been almost two years now since we first started talking, and I was looking back on how very much he'd changed. The most noticeable thing to me is how consistent he is now, along with the much lower intensity of the darkness and despair. Back then, when he was suicidal, it was a constant feature. I never knew from one conversation to the next whether that would be our last talk, so close to the edge he was. But that was a phase...and the phase changed, and the "mood" of that phase "lifted," and now I can look back and think how very long ago that seems, even though it was "just" two years ago.

In trying to find words to convey how much I'd seen him changed, I found the analogy of a staircase, maybe one with gigantic stone steps. It seemed that though he was still climbing -- we all are, of course -- he'd cleared those gigantic steps found at the absolute bottom and walked up a few more as well. Now when he slides back down, as we all do, also to some degree -- he no longer hits rock bottom --- so it might still be low, but it's much farther up from where he was, and that progress he made, he gets to keep.

He agreed, and said that it wasn't so much that the demon of despair wasn't there anymore, as that it was something he could now overcome. "Healing," he said, "is when you're able to use what you've been taught" from all those hard experiences. And one of the most key, is not to give up, but to do what you know to do. Whether it's to stay on the lowest dosage of the medications that keep you functional; or the healing techniques you know can help -- whether by going to a practitioner, or even the ones you can practice yourself. And ideally both: appropriate medication AND healing work. Together: an excellent, therapeutic combination. Singly? Not so much. It's like there's something missing...and there is. Synergy, for one thing.

St. Patrick's Day is this vet's "Alive Day," or as he used to call it, his "Kill Day." The day that everyone else was shot or killed, and he was shot and almost died, and barely didn't. Not a major celebration in his life; one with a whole lot of guilt for surviving, and one guy in particular who died who was a short-timer, and went into the fight with him because of their friendship.

St. Patrick's Day last year, this vet was doing great. On his medication AND doing healing work. Pleasant, engaged, out in public (even in crowded places), managing, letting his whole personality out, the bad as well as the substantial good. Major progress.

This year, St. Patrick's Day, not so much. Kinda "backslid," as the old churches would say. Had abruptly stopped his medication, because he wanted to "feel again," or "feel more." And what he felt wasn't so pleasant for him or anyone he was around. His personality was coming out then too: but it was the dark side, with only glimmers of the light.

That was a learning experience, for everyone. Get back on the meds, but don't stop the healing work either. They're BOTH important. They both produce the synergy necessary. With both, he says, he's able to stabilize; see the triggers and the red flags for what they are, but not react in the same way. Without the medication? As he describes it, "I'm looking for the switch..." to turn off the triggers "but there is no switch." Together, it works. And together with support from others: WE all work better too :-)

(Interestingly, though, he was still able to do one major thing THIS St. Patrick's Day. He told the story, in a powerful, moving and very public way, of the last seven days of his friend's life, leading up to his tragic death on that infamous "Kill Day." He said he'd never before had the strength to tell that story, and this time he did. Fellow combat vets eyed him nervously, preparing for the big crash...that never came. How well did he make it through? With an enormous sigh of relief. He went to bed and slept deeply, finally able to lay that burden down that had dogged him for 43 years. He was able to let the haunting memory go, without giving up the love of his friend. And that's what you'd call...healing. Bonus points were when the dead friend came to him in a dream that night, and they saluted one another. As though it were safe to let that memory go...but let the love remain.)

---

"Life for me ain't been no crystal stair," the great American poet Langston Hughes wrote in his poem, "Mother to Son."

It's had tacks in it,

And splinters,

And boards torn up,

And places with no carpet on the floor --

Bare.

But all the time

I'se been a-climbin' on,

And reachin' landin's,

And turnin' corners,

And sometimes goin' in the dark

Where there ain't been no light.

So, boy, don't you turn back.

Don't you set down on the steps.

'Cause you finds it's kinder hard.

-- "Mother to Son," by Langston Hughes.

The same could be said by so many veterans who suffer. But yet there is still hope, and it's in the climbing, not the "setting" down :-)

Returning to the conversation with the Vietnam vet, I told him how much I appreciate the consistency since he's been back on the low dose of medication he takes. Failing to find a better word, I said how much I appreciated getting to see his "charming" personality again, instead of the roller-coaster of pain, frustration, anger and despair. "ALL of these guys have charming personalities," he reminded me; "That's why their wives married them...And that's what we've got to help them return to."

"Healing" vs. "Curing": What's in a Name?

"OMG," the new reader appears to shriek, "PTSD can't be CURED, my doctor just told me so!" "He told me I'd have this the rest of my life," with the implication being, "so get used to it." So how can you have the audacity to call this "Healing Combat Trauma?" If PTSD can't be cured...

Well, Lordy, what's in a name? There's a big difference between "healing" and "curing," and the difference is at once subtle, and enormous. A good dictionary, such as the American Heritage Dictionary of the English Language, would have excellent definitions of each word, and by delving into them, we would understand the nuanced, but dramatic, differences between the two.

Unfortunately, that's not online, and I tossed my actual copy a long time ago. So all I've got is Merriam-Webster online, which isn't nearly as ... intellectually satisfying and precise with language. But let's have a go at it.

"Health," they define as "the condition of being sound in body, mind or spirit"; (hey, we'd like all three, but that's just us); "freedom from disease or pain"; and a "flourishing condition." Great.

"Healing," by extension, would be returning someone TO that condition. "Curing" would be reversing a disease process. And "treating" would just be the basic addressing of any condition by any therapeutic method, without regard to whether it worked or not.

From personal experience now. Taking a combat veteran with decades of severe, chronic PTSD around to various "treatments," after a particularly successful session, he would want to pronounce himself "cured." Which always provoked a conversation about really, what did "cure" mean, and was it likely to be a one-shot experience? Do this, feel better; great, now you're cured. Nope, not likely. Not from something as insidious, and comprehensively destructive in so many ways, over so many years, as PTSD from combat can be.

I tried to change the conversation. Healing was a better metric than curing; because "curing" implied a single event, a toggle switch that could be flipped between "sick" one day and "well" the next. Healing, on the other hand, was a progression. A whole continuum between being very sick...and being relatively healthy. And any point along that path. Somehow "healing" seemed more attractive and functionally useful a concept than "curing." Can PTSD be cured? Can the veteran with PTSD be healed? Better question. And what will healing look like? It may be when the symptoms that plagued you are somehow more manageable, and the destructive effects of PTSD are affecting the life of the veteran -- and consequently his family and loved ones -- less and less.

Healing or cure? I'll go for healing, every time. It's a path, not a toggle switch. It's not a pill, it's a process. And it's eminently achievable. Don't give up hope. It's part of how you get there. And every little bit COUNTS.

Quotable Quotes -- Confucius on Walking the Healing Path

""Our greatest glory is not in never falling, but in rising every time we fall." -- Confucius, Chinese philosopher and reformer. (551 BC - 479 BC.)

And also:

"It does not matter how slowly you go so long as you do not stop." -- Confucius.

"The Vast Majority of (Vietnam) Veterans Have Melted Back into Society..."

In reading a book tonight, "A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century," by Ben Shephard, Cambridge: Harvard University Press (2001), I came across this interesting paragraph:

"Yet a Los Angeles Times survey of veterans in 1975 concluded that, overall, 'there is ample evidence to suggest that the vast majority of Vietnam veterans have melted back into society as successfully as any soldier from any war.' Vietnam veterans were joining the traditional veterans' organizations, using the GI Bill for education in greater numbers than any previous generation, and successfully getting off heroin. Only 2% of Vietnam veterans used narcotics in civilian life. The LA Times quoted a VA psychiatrist: 'Our society was scared by the image of the Vietnam veteran coming home and shooting up the community, of being a junkie. It was a distorted image that the veteran is still paying for.' There was, he believed, 'no evidence that Vietnam has produced a disproportionate share of people who are maladjusted to society and no evidence that the primary contributor to that maladjustment was military service.'"

I wonder if even Vietnam veterans would agree with that appraisal. It seems awfully rosy. There's a tendency when people first get back to want to fit back in, as though nothing ever happened. I wonder if they caught the respondents at that phase, before they had had significant adjustment issues. The old statistic was that it took veterans, including Vietnam veterans, 13 years to become  homeless, because it took that long for safety nets of family support and employment to fail. The statistics coming back from England with more recent wars is that it's taking three years, not 13, so the pace is escalating. A survey taken in 1975 would have been within that window. It's germane to note that the PTSD diagnosis did not become part of the DSM until 1980. Prior to that, according to "A War of Nerves," one prominent psychiatrist (Chaim Shatan) "argued in 1974 that there were probably one to one and half million men suffering from 'post-combat syndrome,'" while four years later, Arthur Egendorf, Ph.D., a psychologist and Army veteran himself, "(using looser criteria)" put the number at "over two million, a figure almost ten times as great." By 1982, the book says, "another article ... declared that 500,000-700,000 veterans were 'in need of emotional help at the present time.'"

A more common experience would seem to be that of a conversation I had with a friend today. She was talking about her uncle, who she never knew, who had served in Vietnam. According to his mother, she had "two" sons: the son who went off to war, and the one who returned. Her son's platoon was wiped out; only he survived; and he came back, and never really rejoined society. From the sounds of things, he got high, and stayed high, pretty much since he got back from Vietnam. And has never been able to have a job in which people contact is a requirement. Sad tale, and not an uncommon one from the era.

"The Hell of War Comes Home" Almost Nets Reporter a Pulitzer Prize

The Pulitzer Prizes in journalism were announced today. A semi-finalist in the "local reporting" category was Dave Philipps of The (Colorado Springs) Gazette for" his stories on the spike in violence in a battered combat brigade returning to Fort Carson after bloody deployments to Iraq, leading to increased mental health care for soldiers."

Go here to read the series, "The Hell of War Comes Home." The link goes to the first installment in the series; other installments are linked to that initial article. There's also video.

Unlikely Bedfellows: Sun Tzu and George Washington on How to Treat Veterans

It's remarkable that through the ages these two leaders and military strategists yet had expressed such a similar thought about the heart behind how to care for veterans. See if you don't agree:

"Regard your soldiers as your children, and they will follow you into the deepest valleys. Look on them as your own beloved sons, and they will stand by you even unto death!" -- Sun Tzu, from his martial classic, "The Art of War"

- and -

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

Editor's note: Chaplain Kathie Costos, familiar to many as "Nam Guardian Angel," and a true source of wisdom and compassion at her site, Wounded Times and beyond, uses the George Washington line as her email signature, an ever-present reminder of the importance of doing just that.

Quotable Quotes -- Arthur Egendorf on When Healing Happens

“Healing occurs as we develop the openness, care and vision to cast in a worthy light whatever appears before us." -- Arthur Egendorf, Ph.D., from "Healing from the War: Trauma and Transformation after Vietnam," coincidentally my very favorite book on the subject, although unfortunately it's also out of print.

Quotable Quotes -- Carl Jung on Consciousness and Pain

"There is no coming to consciousness except through pain." -- Carl Jung, Swiss psychotherapist.

(With thanks to Kayla Williams, author of "Love My Rifle More Than You," for a great quote...)

Starting in July, Georgia's Driver's Licenses Will Show That Veteran Has PTSD

In an unusual and progressive move nationally, the state of Georgia has passed legislation that effective July, 2010, veterans with post-traumatic stress disorder (PTSD) can have that notification on their driver's licenses. Apparently some graphical symbol, as yet undisclosed, will clarify that the license-holder has PTSD. Read more about the legislation, here.

This seems to be a good idea, because it's important for law enforcement and first responders to know if the person they're stopping, arresting or treating has PTSD. It can make the experience go better for everyone involved, especially if coupled with training.

Editor's note: The image of the license here is just a Georgia driver's license sample, not how the proposed driver's license with PTSD notation will look.

Quotable Quotes -- Dwight D. Eisenhower on Inner and Outer Peace

"There can never be peace between nations until there is first known that true peace which is within the souls of men." -- U.S. president and five star Army general Dwight D. Eisenhower.

Quotable Quotes -- World War I British Doctor on Humane Treatment for PTSD

" Do not send your cases down the line ... when you get these emotional cases, unless they are very bad ... give him a rest at the aid post if necessary and a day or two’s sleep, go up with him to the front line, and, when there, see him often, sit down beside him and talk to him about the war or look through his periscope and let the man see you are taking an interest in him, [and] you will not have nearly so many cases of anxiety neurosis." -- Col. J. S. Y. Rogers, 4/Black Watch, Report of the War Office Committee of Enquiry into 'Shell-Shock’ (London, HMSO, 1922), 64. Quoted in "'Pitiless psychology': the role of prevention in British military psychiatry in the second world war," by Ben Shepard, published in The History of Psychiatry, 1999; 10; 491, linked in full here.

Quotable Quotes -- Helen Keller on Overcoming Suffering

"Although the world is full of suffering, it is full also of the overcoming of it." -- Helen Keller

Quotable Quotes -- The Healing Process

"Heal the traumas, and the person's natural processes take over and the diseases fade away. The healing treats the traumas, and then the body naturally does what it was prevented from doing by the trauma. My friends in other therapies essentially follow this process. Healers do it. Massage therapists do it. Osteopaths do it. Psychotherapists do it in one way or another. That is the universal process we all have to go through to recover from trauma and live our lives to the full." -- Peter Chappell, "Emotional Healing with Homeopathy: Treating the Effects of Trauma."

Quotable Quotes -- Nate Fick on Combat Veterans, PTSD and Reintegration

"It took me a year to adjust after coming home from Iraq. Afghanistan was different -- it wasn't very violent and we came back on a ship. I had a month, including some vacation time in Perth and Sydney, before getting back to the States. But I left Iraq on a Sunday night, and was in San Diego on Tuesday. It was surreal. I had all the stereotypical little signs of post-traumatic stress disorder -- jumping at loud noises, nervous in crowds, short-tempered, insomnia. And you know what? I came back to a loving family and supportive friends. I had a good education and solid prospects for the future. This experience almost unhinged me. What about all the men and women who don't have the support I had? What happens to them? This is a question the military -- and our society more generally -- should be addressing. We'll have something like half a million combat veterans trying to reintegrate into American society over the next few years. They can be a source of wisdom or of destruction. It depends on how well we care for them." -- Nathaniel C. Fick, former Marine captain, author of "One Bullet Away: The Making of a Marine Officer."

Quotable Quotes -- Nate Fick on Understanding War and the Warrior

"This country needs its professional warriors. It also needs people in other walks of life who know what the decision to go to war means." -- Nathaniel C. Fick, former Marine captain, author of "One Bullet Away: The Making of a Marine Officer."

Quotable Quotes -- e.e. cummings on Unbracketing Death

In honor of April being "National Poetry Month," a wonderful excerpt from American poet e.e. cummings (1894-1962) about the continuity of life beyond life. Cummings was no stranger to war and its aftermath: he's one of several famous writers and poets who served as ambulance drivers, in his case, in World War I. This snippet of his poem, "since feeling is first," (Cummings was a big fan of unusual capitalization and punctuation) neatly conveys the impact of a life that goes on past its close, in the memory of the survivors left behind. In the right context, these words offer some small comfort, whether you're thinking about your own legacy, or remembering those you love who've gone before you:

"For life's not a paragraph And death I think is no parenthesis."

Quotable Quotes -- What Healing Is...

"Healing is about opening what has been closed, reclaiming what has been hidden and remembering what has been forgotten." -- Mary O'Malley, "The Gift of Our Compulsions."

Quotable Quotes -- Voltaire on Letting Nature, Not the Physician, Do the Work

"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire. 1694-1778. French author, humanist, rationalist and satirist.

Quotable Quotes -- Sir William Osler on Treating the Patient, Not the Disease

“The good physician treats the disease; the great physician treats the patient who has the disease.” -- Sir William Osler, 1849-1919. Often considered "the father of modern medicine."

Quotable Quotes -- Sir William Osler on Individualized Patient Care

"It is much more important to know what sort of patient has a disease than what sort of a disease a patient has." -- Sir William Osler, 1849-1919, often considered the "father of modern medicine."

Quotable Quotes -- Lonny Jarrett on the Tao of Healing

"No human resolution can make up for the loss created by injury.  The only real healing comes from rolling the two of right and wrong back into the one primordial Tao in which all opposites are harmonized.  Along these lines, the Tao te Ching advises us not to seek justice but rather to 'repay injury with 'te' (virtue)'."--Lonny Jarrett, in "The Empty Vessel" magazine, Spring 2000.

Editor's note: We've talked an awful lot about the essential nature of "integration" on this site. Many, many posts reference it. Look for it particularly in the "Spirituality" section, linked here. Also be on the lookout for it in your life and others...

 

Quotable Quotes -- Lonny Jarrett on the Meaning of Healing

"We may only be considered to be healed when the damaging events of life no longer limit self-expression and the manifestation of life's purpose." -- Lonny Jarrett, in "The Empty Vessel" magazine, Spring 2000.

Quotable Quotes -- The Tao on the Cycle of Healing Following Upheaval

"All life is continual destruction and healing, over and over again. That is why, even in the midst of an extreme situation, the wise are patient. Whether the situation is illness, calamity, or their own anger, they know that healing will follow upheaval." -- Deng Ming-Dao, 365 Tao.

Editor's note: This most painterly photograph is by Zoriah, whose incredible work -- humanitarian photography from war-torn parts of the world -- is at www.Zoriah.com.

Quotable Quotes -- Joseph Pizzorno on Preventative Wellness

"Half the costs of illness are wasted on conditions that could be prevented." -- Joseph Pizzorno, N.D., naturopath, author and one of the founders of Seattle's Bastyr University.

Quotable Quotes -- Thich Nhat Hanh on Health

"Keeping the body healthy is an expression of gratitude to the whole cosmos -- the trees, clouds, everything." -- Thich Nhat Hanh.

Editor's note: For more on Thich Nhat Hanh, who has one of the most wonderful quotes about veterans being "a force for healing in the world," go here. Claude Anshin Thomas, a Vietnam veteran and former Army soldier who wrote a powerful book we've talked about quite a bit on this site, called At Hell's Gate: A Soldier's Journey from War to Peace, has been profoundly influenced by his interaction with Thich Nhat Hanh and his work.

Quotable Quotes -- Hippocrates on Healing

"Healing is a matter of time, but is sometimes also a matter of opportunity." -- Hippocrates, the father of Western medicine. (460-377 B.C.E.)