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Across the Nation

June 28, 2008

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

Disposable Heroes 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

Chantix PTSDAn 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

Bfportraitsmall 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.

June 19, 2008

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

IStock_000000618862XSmall 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 trops 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

NPR Logo 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.

June 14, 2008

Chaplain John Morris, Minnesota National Guard

Chaplain John MorrisCaveat 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.)

June 13, 2008

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

CIMG0819 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.

June 07, 2008

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

Travis Twiggs Still a Hero 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 Twiggs Heroic Family 3 of 4 Total 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.

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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."

A World of Pain Within 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