Healing Combat Trauma

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.

Picking up the Pieces of Shattered Lives: Treatment or Prison

The other day was a momentous day in the life of two different combat vets. One, an older warrior, Marine, from the Vietnam war, the other, an Army vet, from the war in Iraq. Each of them wounded in combat.  Each of them knowing  intimately the sufferings of PTSD. Each of them having failed, at various times, sometimes spectacularly, other times less so, at "keeping it together" or being the person they wanted to be, for themselves, their employers or their families, because of their PTSD.

Yet what brought the two together this day was the one taking the other to an inpatient PTSD program at the VA; the older bringing the younger to a program he’d gone through himself, years ago; and one vet to another, the Vietnam vet to the Iraq war vet, encouraging him to pay attention, and to begin the process of change.

 Nobody goes to an inpatient program because they're doing so astoundingly well with their life or with their PTSD symptoms. Sometimes it's a diversionary program offered in the place of jail, which is why the Iraq vet this week was going. Drinking heavily, he'd been arrested for domestic violence, and the older vet stood up for him in court, but requested that the judge send him to treatment, in lieu of further jail time. This time, the Iraq vet was "lucky." There was room for him in the program. Many other Iraq and Afghanistan war vets -- Gulf war vets -- Vietnam vets -- have not been so lucky. They end up with extensive prison sentences for being in the wrong place at the wrong time, and getting arrested when their finely-tuned combat-trained hair-trigger reactions are out of sync with civilian life.

Talking with some young Iraq and Afghanistan combat vets a few months ago, guys who were residents in another cutting-edge residential treatment program for PTSD, they told similar stories, of having been given the chance to do the inpatient program after being arrested for something they did, fully inappropriate for the civilian world, when they first returned from combat. One guy told a story of going with his wife and kids to Walmart, and having her touch him from behind, which startled him, and as he told the story, when he "came to," he had his hands around his wife's neck, choking her. An inpatient PTSD program seemed like a better choice than jail. And for what it's worth, it did sound like he was sorry, and it also sounded like his wife was still with him -- but, everyone involved acknowledged that he needed treatment, including him.

It's reasonable to ask, how do we know whether inpatient programs do much good for the combat veterans with PTSD who go through them? We'll have to wait and hear from the graduates, but also, watch their lives, so to speak, for years afterwards, and see how things really turn out.

The older combat vet, the Marine, who took the younger vet to the program the other day, recalls that from the graduating class of his own program, most today are dead: many took their own lives, despite what they'd learned in the program. At most, he credits the time in his own life with learning to recognize what many of the danger signals of PTSD are, the "red flags" that a situation is escalating. At this remove, he considers what he learned to be "behavior management" -- learning coping skills for managing a disorder that nobody really expected to be healed or cured, at least through conventional means. Hmmmn.

In other parts of the country, veterans are doing jail time for similar offenses, even some seemingly more light-weight. Whether a veteran goes to a treatment program or to jail seems at this point to be mostly the luck of the draw. There’s also some concern, among veterans advocates and others, that the way police arrest combat vets with PTSD can further escalate the vets’ reactions. Many first responders are military veterans themselves, sometimes with their own cases of PTSD – from combat or the job. Training is needed so that arresting a combat veteran in the throes of a PTSD-fueled reaction can go as smoothly as possible, with as little collateral damage as possible. Additionally, when combat veterans with PTSD are arrested and imprisoned, they lose their VA benefits – and are often left completely untreated. This only compounds the problem/tragedy further.

Jamie Keyes daily endures the struggle of knowing that her son, Nathan, jailed for a PTSD-fueled reaction, might have benefited from treatment, but instead is doing time. A highlight of her Christmas vacation was driving to another state, where he is jailed, to spend a few short hours with him. She worries what incarceration will do to her son, and even to her elderly father, who raised Nathan as a boy, and is heartbroken to know that he’s in jail.

The story of what happened to Nathan Keyes is here – but if you want to see a mother’s perspective even more strongly, watch the video she made about Nathan, here, before his trial.

Jamie Keyes writes, 

“This is a tribute to my son, Nathan Keyes, who is a veteran with PTSD. Nathan spent 8 years in the Army and two long tours in Iraq, before returning home bearing the mental wounds of war. Nathan is now incarcerated for an act resulting from his PTSD, and will spend three years in prison. The state of Florida wanted to give him more than 15 years for his offense, instead of giving him treatment. Instead he took a plea deal that will leave him with a felony record for the rest of his life and 3 years in prison without treatment. Nathan sought help from the VA but never got adequate treatment, and was subsequently failed by our criminal justice system. This is how we treat the returning veterans in this country. This type of incident is happening in epidemic proportions all over this country, and it is a dishonor to those who so selflessly served their country.”

Treating combat veterans with PTSD who commit crimes in inpatient PTSD programs “sounds” a lot better, on the surface, than jail time – definitely. Questions still remain about how effective the inpatient treatment programs are, but it’s obvious that they’re preferable to jail – which takes away the opportunity for treatment, and further harms the veteran, on several levels. However – it’s also necessary that first responders learn how to arrest combat veterans with PTSD who may be in the middle of a PTSD episode when they’re arrested. No one knows right now how many police departments across the U.S. even recognize this is an issue to be addressed. Ideally, before too long, all first responders will be trained to recognize the signs and symptoms of PTSD and how to deal with combat veterans when they have to arrest them. Averting forseeable tragedies is always a worthy goal.

Escaping from the Bamboo Chest

Every once in a while I come across a book about war and healing combat trauma that's new to me, and such was the case recently with one by Frederick Graham, called "The Bamboo Chest: An Adventure in Healing the Trauma of War," linked here. Unfortunately, the subtitle is a bit of a misnomer, unless you interpret it in a particularly specific way, in which case it works.  But while it's far afield from actual "healing combat trauma," the reality is, it's an amazing true-life adventure story by someone who understands he's very lucky to be able to tell it. 

For those of us who grew up reading books like Papillon, by Henri Charriere, who uses the opportunity of his captivity in and subsequent escapes from the notorious French prison, Devil's Island, to teach himself some things about himself, or any of the wonderful high-adventure historical novels by James Clavell -- Shogun, Tai-Pan, King Rat, Noble House, etc. -- Graham's book fits right in.  It's a remarkable story about a guy whose dad was a Marine, who grew up in and around Vietnam and Southeast Asia, and then finds himself imprisoned in a South Vietnamese jail in the 1980s, with an absolutely frustrating roommate who he'd been arrested with and grows to really detest, for all the right reasons.  Graham uses the opportunity of his imprisonment to reflect and make adjustments to his character, finds and nurtures his inner strength, and experiences several important insights from his childhood around the war in Vietnam that helps his adult self integrate itself more completely. 

Unfortunately, though Graham is plenty psychologically adept with his own experience, because he wasn't actually involved in the Vietnam war directly as a soldier, the "war" in the subtitle is at a slightly larger remove than it was for the actual participants.  However, as a story about man against the elements -- particularly man against society, and in some ways, man against himself -- it's really quite an exciting tale, and one worth reading.

Travis Twiggs: The Un-Happy One Year Anniversary of Combat PTSD's Perhaps Most Visible Death

Just a brief note to mention, it was one year ago today that Travis Twiggs passed from this earth, by his own hand, the veritable poster boy of combat-based PTSD.  It also marks his brother Willard's passing, who left this earth with Travis, apparently by Travis' hand.  It's an absolute tragedy, for any number of reasons -- from the family members and friends the Twiggs brothers leave behind -- to the fact that Travis, personally, was making an impact as a Marine who broke the code of silence, so to speak, and spoke openly about his PTSD.  Twiggs wrote about his ordeal in the January, 2008 issue of the Marine Corps Gazette, in an article that has been widely circulated, and is still available on the Web.

Travis Twiggs' suffering was something that really stood out to me -- perhaps because of his very willingness to speak openly about his struggles, something Marines.Just.Don't.Do.  We actually broke the news of his death on this blog, before the mainstream media had reported on it -- and in fact, the early reports were wrong on the facts but widely repeated, making the damage that much more painful.  (He and his brother were reputed to be hardened criminals, for example, which they were not, although they had been -- at the last -- involved in a carjacking, as part of their initially ill-fated but ultimately successful desire to end their lives.  In fact, Twiggs was a much-decorated Marine with multiple combat tours behind him, who had recently met the president, and whose Marines (and his family) deeply loved him.  His brother, Willard, was well-loved as well.  A year later, not a day goes by that people don't find this site out of a search they're doing for Travis or Willard; and in the days after their death, searches for Willard were almost as popular as those for Travis, though Willard was obviously shyer and less well known. And these tragedies were not the only ones the Twiggs family suffered in a very short amount of time: their beloved grandmother also passed away within days of the Twiggs' brothers' deaths. Hard, hard times for the Twiggs' family, and for all those who loved Travis and Willard.

It's hard to explain my own involvement in this saga except to say, I had a bad feeling about how Travis was really doing, without even knowing him, just based on reading what he wrote, and how it didn't seem to add up.  So the month before, without realizing he'd already been confined to an inpatient PTSD program at Bethesda Naval Hospital, and was therefore unable to answer, I repeatedly tried to get ahold of him and/or the Marine Corps Gazette, which had published his somewhat optimistic article months before.  When neither would reply, I started to really worry that something was amiss.  Then when the first news reports came out of the National Park Service about the "armed, tattooed and dangerous" Twiggs brothers, involved in a carjacking, I just knew it had to be Travis, and that things had somehow gone terribly wrong. Hoping to offset the "bad news" (and mistaken news" about who Twiggs really was -- not a lifelong criminal, but a decorated Marine, who everyone loved, who'd struggled mightily with PTSD -- I went out on a limb, and wrote, as I realized he was dying, what became a "PTSD obituary" to this at the time unknown Marine, who'd undoubtedly died from the consequences of his uncured, but not untreated PTSD.

In the days that followed, as I waited for any national attention to be focused on his case -- none was -- the blog here received heavy, heavy traffic, as those who loved Travis and his brother came to essentially pay their respects, much as I had tried to myself, and also tried to come to terms with the brothers' passing.  Over time, various reporters kicked into gear and started covering the Twiggs' story in lengthy pieces. (I had to put the "use with attribution" notice up on this blog when one reporter spent, no joke, 40 hours mining this site, without acknowledging where he got his information.  Ugh.) Richard Ruelas wrote about the saga for the Arizona Republic (the brothers had died in Arizona), Bill Finnegan's at the New Yorker magazine, and there was a two-part series in the New Orleans-based Times Picayune. CNN, to its discredit, never once mentioned the brothers' passing.  I think once they missed the initial window, it was too embarrassing to catch up, but to this day, they never have, whereas pretty much everyone else has had something to say about it -- or them.

While many, many aspects of being the one to break this story -- on a blog, not in a newspaper or a wire service -- have been exceedingly frustrating, I'll spare you my angst on that one.  The blessings have also been there -- getting to "meet" online and sometimes in person, some of the key players in the brothers' lives, and have them express their appreciation for what I did to help to humanize their brothers, while the rest of the print world was essentially doing the opposite (at least initially). I'm still concerned for how Travis' wife, now his widow, Kellee, to whom the news of Travis' whereabouts and obviously his death, came about as a shock, as well as for the Twiggs' parents, whose loss of two sons at once is just incalculable.

In the New Age-y world, people do talk about being careful about what your intention is, and how your intention will carry the day.  Without going into what "intention" means, overmuch, it can be simplified to say, whatever the vision is of an outcome, that you carry in your heart, or that you express to the world.  In this case, it was very, very clear.  Back exactly a year ago today, as Travis Twiggs and his brother were in their last moments, and time was running out, I wanted the world to NEVER FORGET who Travis Twiggs was, and what the legacy of unresolved PTSD looks like.  If ever there were a poster child for PTSD, it was Travis Twiggs.  He took the first step when he told the world his secret in that powerful, much-read article in the Marine Corps Gazette, when he broke the silence for his Marines, and the rest of OEF/OIF veterans.  What I held in my heart that day -- despite the professional disappointments that may have followed -- was that when people thought of PTSD, they would think of Travis Twiggs.  And given that his legacy is still very much alive, one year later, I do believe that intention accomplished exactly what it was supposed to.

As Twiggs himself said, he was willing to come forward and talk about what he went through, because he wanted no other soldier, sailor, airman or Marine to suffer like he had -- in silence.  With his death, and that of his brother, unfortunately for the much-beloved Twiggs brothers, but mercifully for the rest of us -- it's a conversation we will all keep having.  RIP, Travis and Willard Twiggs. You are not forgotten.

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Editor's note: The original blog entries about Travis Twiggs from a year ago are: "One Marine Reflects on His Battle with PTSD," linked here (before his death); "PTSD -- "The War Within" -- Claims Another Victim," linked here; "RIP Travis N. Twiggs, USMC PTSD Sufferer," linked here; "The Ballad of Travis Twiggs," linked here; "Travis Twiggs' Suicide - Only Questions Remain," linked here; "The PTSD Obituary for Travis Twiggs," linked here; "Bleeding Green with PTSD," linked here; "Twiggs' Wife: 'The PTSD Drove Him Crazy'," linked here; "The Tragic Last Days of Travis 'T-Bo' Twiggs," linked here; "Travis Twiggs' Widow, Kellee, Puts a Human Face on the Suffering of PTSD," linked here;and, finally, "SSgt. Travis Twiggs - Well-Loved U.S. Marine and Hurting PTSD Hero - the Update," linked here.

Violence at Camp Liberty: Shocked, Maybe, but Not Surprised

 Allow a little venting of spleen here: The violence at Camp Liberty today in Iraq, where an American active duty servicemember allegedly opened fire on others at the stress clinic, a location where other servicemembers go for counseling, killing 5 at 2:00 p.m. local time -- if we're shocked that this happened, that's okay; but seriously, America-- why are we still "surprised"?!

Here's 10 reasons NOT to be surprised, though feel free to continue to be shocked:

1.    Tours are too long, putting considerable and unprecedented strain on the all-volunteer military. The AP reports, "The U.S. military is coping with a growing number of stress cases among soldiers in Iraq and Afghanistan - many of whom are on their third or fourth combat tours. Some studies suggest that about 15 percent of soldiers returning from Iraq suffer from some sort of emotional problems." The ones who initially deployed?  Strong and willing.  But as the tours wore on, how many stayed that way?  Certainly not everybody.
2.    Resources for stress management are inadequate, and there's often peer pressure not to make use or take advantage of them -- and then the broader question: what are we really offering to help soldiers heal?  Is there anything in the conventional medical world that's actually working? There's talk therapy and there's medication, and those who follow this topic in-depth know that there are problems with either or both of those approaches.  Anecdotally, of the three combat veterans whose lives I follow most closely, all three of whom had recently pronounced substantial healing  -- two of the three who relied on the most conventional approaches -- were re-hospitalized within the past month for psychiatric reasons, each within several weeks of pronouncing how much better they were doing, thanks to their course of treatment.  (The third combat veteran, who follows a less conventional path, is actually truly doing better -- or so it would currently seem.) When it comes to combat-based PTSD, the "cure," such as it is -- is a long way off -- particularly if we only look along conventional channels.
3.    Access to firearms is...ummm...not an issue: they're everywhere.  It's war, and we're armed to the teeth.  It's part of what we do.  But carrying a weapon in a stress clinic?  Doesn't seem on the face of it to be a wise safety choice;
4.    Workplace violence is a fact of civilian life, too: OSHA reports that homicide is the fourth leading cause of workplace fatalities. On an average workday, according to one site, "three people will be murdered on the job in the U.S."  Annually, "one million workers are assaulted, and more than 1,000 are murdered." Concerns are that half these cases go unreported, so the figures might even be doubled. Mondays, in fact -- today  when the Camp Liberty incident took place is a Monday, after all -- are a prime time for incidents to take place.  Something about people stewing about their real or imaginary mistreatment over the weekend, and coming back in and deciding to "do something about it."  Read the cases: Monday is often when disgruntled American workers, at the very least, choose to settle the score;
5.    Sleep deprivation is a chronic problem in the over-extended military.  As a technique for inducing symptoms along the spectrum from abject misery to forms of psychosis, it's effective enough that it's used (by the U.S.) as a form of torture, like waterboarding. Going without sleep, which the military chronically does, puts soldiers at risk on a regular basis.  Not that there are any easy answers to this, but that needs to be taken into account. Not sleeping is very dangerous to your health: and if to yours, by extension to those around you, too. Experts like veterans advocate Jonathan Shay, M.D., Ph.D. have long warned about the dangers of exhaustion and sleep-deprivation.  It's time to pay greater attention;
6.    Talking heads and pundits attempt to minimize the problem by saying, it's only the fifth case of soldiers killing one another since the war began but REALLY -- are they serious?!  How about adding the qualifier, "known" case -- as in, proven.  (Even the New York Times said, more accurately, "The killing of American troops by their fellow soldiers is infrequent, but not unheard of.") Think of the many cases of noncombat deaths in Iraq.  How many of these, because of insufficient, inadequate, or misguided investigations -- or cover-ups -- might turn out to be soldier upon soldier violence, if we but knew the facts? A percentage of the noncombat deaths are murders, not just accidents or suicide.
7.    Felony waivers. While many -- or most -- of the military may be fine and upstanding individuals -- better, in fact, than most of their less patriotric, more self-centered peers -- the reality is, as the war continues, an increasing few who have less savory backgrounds or mental states are being given waivers and allowed to join anyway -- then deployed with the rest of the troops, and put under the same types of strain, which perhaps they don't bear very well -- or as well as their peers;
8.    If recruiter suicides are up (and they are) -- recruiters being in a good position to know the true costs of going to war on the troops -- and suicide is effectively giving up on their being a solution to one's problems -- shouldn't  this ring some greater warning bell than it has, that perhaps we're asking people to do and to sacrifice, far beyond their actual ability to?
9.    We can't discount the fact that some people are just unbalanced -- and some of the ones who are, unavoidably, also serve in the military.  The last well-publicized statistic on the subject was that roughly 10% of the (overall) population suffers from mental illness. Some of these people are in the military, and under stresses and strains greater than most of us have ever endured, some will snap.  that in itself should not really...surprise us.  It's not a diss against the military: it's a fact of life. If anything their challenges are stronger than anyone else's.
10.  Interpersonal violence and suicide are both extreme versions of "lashing out" at what's perceived to be an unjust fate.  Domestic violence rates in the military ARE worthy of some "shock 'n awe" of their own.  During the same news cycle, where the Camp Liberty incident is being broadcast across all possible news outlets, other, equally horrendous incidents are also happening among servicemembers and veterans -- horrendous to the victims and their families, as well as to the families of those who commit the crimes. Here's an example of the same from today's news cycle, though it's all been pushed off the page by the greater prominence of the Baghdad story. The Colorado Springs Gazette reports that Thomas Woolly, 24, was arrested in the shooting death of a 19-year-old woman.  As the Gazette describes, "Woolly ... was a heavy machine gunner in the 4th Infantry Division's 2nd Battalion, 12th Infantry Regiment.  Members of the 500-soldier unit, nicknamed the Lethal Warriors, have been involved in stabbings, beatings, brawls, domestic violence, shootings, at least two attempted murders and four homicides in Colorado Springs. Another soldier who served with the unit in Iraq has been accused of murder in California. The unit has also been plagued by drug abuse and suicide..."

By bringing this up -- that this violence might be "shocking," but surely shouldn't be "surprising" -- it isn't intended to single out servicemembers or veterans as "bad" -- if anything, they're under abnormally large stressors.  It is to say, this stuff happens -- not always as well broadcast as when it happens in a group.  But it happens all the same. Forgetting even Iraq and Afghanistan for the moment -- across AMERICA -- do we honestly believe that fewer than five people -- including the servicemembers and veterans involved -- had their lives in actual, mortal danger from incidents like this? (In the Woolly incident above, for example, one woman was killed, but another one was injured, according to published reports.)

Again, if we were but able to "see" across the broad expanse of all the people this affects, and into all their homes and lives, even on one given day, I think we might be quite surprised to see the continuing emotional toll and strain that combat stress and its aftermath produces. Continuing to look at incidents like whatever happened at Camp Liberty today -- as the facts continue to come out, over time -- as "isolated" incidents, instead of a very visible part of the mostly in-visible spectrum of pain and suffering -- only allows us to stay in the dark on this topic a little longer than we should. 

For the health of servicemembers, veterans and their families, it's time to start admitting what a difficult problem we have: and one that takes more than lip service, and conventional modes of treatment, to "handle" and ultimately to "solve."

From a Combat Veteran Himself: A Suggested Guide for PTSD Veteran Charged with a Crime

The other day, we published, with the author's permission, Scott Lee's thoughts as a combat veteran and student of social work, on dissociative PTSD, criminality and the combat veteran.  Today we publish, also with his permission, the guide he wrote for combat veterans and their familiies, when a combat veteran with PTSD has run afoul of the law.  Scott isn't a lawyer, so this isn't legal advice.  But it is wise, compassionate, fellow veteran and fellow PTSD sufferer type advice.  Keep it handy to refer to; it's really, really good.  You can also look through the archives here for things previously written about legal issues and combat trauma.  (See topics like "legal issues," "legal justice," and "crime and punishment.")  Fortunately, in the several years since we started this blog -- at which point there were literally none -- some resources have sprung up in the legal community for helping combat veterans with PTSD to get legal advice for their situations.  There's also a good video by the Norfolk County, Massachusetts' DA's office, which we've blogged about earlier, here, that gives a good overview of the challenges returning veterans face in their communities, including with law enforcement.

 

 

Suggested Guide to Help Your Veteran or Soldier Diagnosed with PTSD, and Charged with a Crime

To whom it may concern,

I would suggest that you start researching about PTSD right away. The mind-body connection and interactions, the psychology of PTSD, defensive mechanisms, how the mind responds to trauma, the symptoms of PTSD, how extended combat (such as multiple tours served) effects soldiers and veterans, legal ramifications of criminal behavior and PTSD, the processes of the psychic split from reality and past combat experiences, how anxiety plays an everyday part of our lives, how ordinary stress can lead to higher levels of stress and extreme responses and flashbacks, the nature of flashbacks, the nature of triggers and how they apply to PTSD, and the mental compartmentalization that happens to a PTSD survivor. This is by no means a comprehensive list, but should give you some kind of idea of where you might want to start.

 

Like it or not, this has consumed your life by no choice of your own, instead of letting that energy overwhelm you and feeling helpless, turn that energy into a useful endeavor and focus it toward finding out as much as possible about PTSD and the effects of combat. You have more passion about this subject than anyone, use this as an opportunity to help your loved one get a fair trial and to force the courts to consider his/her mental illness as a contributing factor in their actions.

 

Do not take no for an answer from his/her lawyer as to your wanting to get involved in your significant others case, jump into his/her pocket and become the "paralegal" and find them the information that needed for fair consideration of the case. Most lawyers will resist this from you, again do not take no for an answer. I am guessing that the lawyer will probably be a public defender; they are overloaded with cases and cannot really give the appropriate attention that their caseload needs. So, you need to assume that role of "defender" and information detective, this can greatly impact the outcome of the trial.

Consider trying to find a high profile lawyer who will take the case on pro bono; this type of case has become a hot topic in the news and media. A lawyer might take a case for this reason and could benefit the outcome. Go to the clerk’s office and get a copy of the court case file, this will help you by becoming familiar with the states perspective on the case and what exactly is being done. Educate yourself in Miranda rights (If they violated his rights here, this could have a considerable impact on the outcome), federal constitutional law concerning 1st, 4th (emphasis here), 5th, 6th and 8th amendments, along with state constitutional law. Educate yourself on how the court works, the proceedings, when and where evidence can be brought, the questioning of witnesses and how that process is different in every aspect of the trial.

Educate yourself on case law concerning PTSD and other mental illnesses where a consideration or precedent has been set, this can be used in your case and can greatly influence what happens. Look into your state laws first as they will have the most sway, because state law guides state cases first, then look to federal law to find precedents and findings where PTSD was considered in the sentencing phase. Concentrate on first on the main trial part where the evidence and witnesses will be displayed then on the sentencing. Both of these parts of the overall court proceedings will be the most important part, your soldier or veteran’s fate will be decided between these two proceedings.

 

Educate yourself on and things to do:  

• Do not talk with the police or anyone else until you have talked with your lawyer, what you say will be used against you

• learn your rights and assert them, you do not have any rights if you do not know your rights

• get a copy of court case file

• get a copy of VA file and military file

• jump in your lawyers pocket

• try to find a pro bono lawyer

• individual rights, Miranda and if they were violated

• legal proceedings, structure of court formalities and rules of law

• psychology of PTSD

• case law, state and federal, concentrating on the main trial and sentencing process

• constitutional law

• legal responsibilities of the judge, your lawyer and the prosecutor

• find a support group

• contact your senator, congressperson

• contact your local VFW, AMVETS, or veterans associations

 

I know that this seems like too much, just figure out what is coming next and then concentrate your efforts into that. Take one court proceeding at a time and concentrate on the legalities of that part of the process and use it as a guide to where you need to research and what you should do. The structure of the next proceedings will be your sign post for the direction you need to concentrate on. You can do this, if you accept that you have been put on this earth for this.

 

You were born to do this; this may be your purpose in life, to be the freedom fighter for all veterans and soldiers who will face similar tribulations. You have more vested in this than anyone else, you have more to lose, do not stand by and be a spectator. Get involved and later you will not have the guilt of "I wish I had done something". A most important issue to face would be finding a support group that you feel safe with and trust. You cannot do this alone, enlist the help of as many people that you can. Contact your congressperson, senator and your local VFW, AMVETS, DAV or American Legion. This is only a suggestion for what to do. I have compiled this list and information as a suggested guide for personal empowerment.

  

Thank you for listening and God bless,

 

Scott Lee

 

Editor's note: Scott Lee has an excellent blog, PTSD: A Soldier's Perspective, linked here, where he talks about his own experiences as a Gulf War combat veteran with PTSD, and his reflections as a student of social work, attempting to learn what he needs to learn, in order to help other combat veterans with their suffering.  Go, Scott!

One Veteran's View - Dissociative PTSD, Criminality and the Combat Veteran

You've heard of Bruce Lee -- warrior, philosopher, actor -- now hear about Scott Lee -- Gulf War combat veteran, social work student, blogger.  Scott writes an excellent blog, PTSD: A Soldier's Perspective, linked here, which has been a finalist for the MilBlog award (given to military bloggers). 

Of particular interest to us, though, is this paper he just completed for a class in social work law, about PTSD, criminality and veterans.  Scott's background as a veteran and a student gives him a unique perspective not shared by most, and what he writes could serve to open many people's eyes to the problems faced by returning combat veterans. 

Scott has kindly given us permission to reprint his paper in full on this blog, so we're going to do that in two parts, because of length.  First up, the section that follows; a subsequent post will include his guide for returning combat veterans and their loved ones, if the veteran has been charged with a crime.  Scott isn't giving legal advice here (nor are we); he's sensitizing us all to the problem at hand.

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Scott Lee writes:

The following is a paper that I have completed for my Social Work Law class, parts of the paper I have been writing about in my blog. The paper ties together the evolution in my train of thought concerning the veteran or soldier consumed by the ravages of full blown PTSD.

 

The paper is long, but relevant to the plight of our returning combat soldiers and veterans. If you want to understand more about why a veteran or soldier runs afoul with law and society then you should read this.

  

VETERANS, DISSOCIATIVE PTSD AND CRIMINALITY

  

Scott A. Lee

Kent School of Social Work, University of Louisville

November 3, 2008

The Modern Combat Veteran:

Dissociative Posttraumatic Stress Disorder & Influences

on Criminality

Statistics

 

As of August 27, 2008, according to the Congressional Research Service (2008) 4,726 soldiers have lost their lives in combat and 32,977 troops were wounded in action, with 8,089 suffering from Traumatic Brain Injury (TBI). The USA Today (2008) reported that 68% of all soldiers have been deployed to a combat zone, 31% have been deployed more than once and 2,358 have had more than five tours of duty.

 

The United States Department of Justice (2004) reports that, “[t]he majority of veterans in State (54%) and Federal (64%) prison served during a wartime period….[that] Vietnam War-era veterans were the most common wartime veterans in both State (36%) and Federal (39%) prison.” The 57% majority of State prisoners were serving time for a violent crime compared to less than half of non-veterans who were serving less time for similar crimes. The report indicates the Iraq-Afghanistan era veterans comprise 4% of both prison populations (U. S. Department of Justice [USDJ], 2004).

 

Posttraumatic Stress Disorder (PTSD), Dissociation and Other Considerations

PTSD is a life-long endeavor; there is no cure for it. The triggering traumatic event changes the landscape of the mind, it no longer works in the same fashion that it did before. The mind has been rewired; the neuropathways have been altered into a continuous loop. The PTSD triggering incident converts the fight or flight response in the primitive portion of our brain. Imagine having that scared feeling you get without the fear while keeping the bodily reactions; the tenseness, the adrenalin rush, the mind racing, heightened senses, and the hyper response reflex to react without thinking.

 

The incident that solidifies the mental wound of PTSD results in a mind numbing, or psychic shift. In response to the trauma of combat, the person needs to make a mental detachment to do what needs to be done. The survival mode of operation forgoes the higher levels of functioning and depends on the primitive reactionary portion of the brain. When this unconscious detachment has been activated to frequently or for extended amounts of time it becomes part of conscious processing and interferes with everyday interactions (Lee, 2006; & Cerone, 2006). According to Howell (2005), dissociation refers to the separation of mental and experiential contents that would normally be connected.

 

The word dissociation is laden with multiple meanings and refers to many kinds of phenomena, processes, and conditions. Dissociation is both adaptive and maladaptive, both verb and noun, both cause and effect….Dissociation is often psychologically defensive, protecting against painful affects and memories, but can also be an organismic an automatic response to immediate danger….Dissociation can be understood as taxonic or, varying in degrees….It is both occurent and dispositional….It refers to such psychical events as spacing out, psychic numbing, and even experiencing oneself as floating above one’s body. Dissociation has been thought of in spatial metaphor, as acts of ‘keeping things apart’ as well as ‘vertical splitting’ (p. 18).

 

The mind can develop into split affective regions where multiple self-states dissociate incompatible values systems and set up residence along with establishing a unified substructure within matching internal guidance systems. The dissociated subsystems run parallel to other self-states and emerge when a particular skill set needs asserting pertaining to situational interactions. Here trauma based disorders may lead the symptomology to further entrenchment and compartmentalization that may lead to personality disorders. “A war veteran with PTSD might have more significant structural dissociation, involving the sequestration of more and larger portions of experience” (p. 22).

 

A defined preconditioned set of beliefs and values, the combat schema enables the warrior to navigate efficiently through the adversity of combat without a detailed consideration of consequences. I propose a unique set of beliefs, Combat Values Theory (CVT), based on the survival of self in relation to the context of war and the “combat-othering”, for we must wholly demonize our adversary and in the process dehumanize ourselves. The combat veterans primitive fight or flight defensive mechanism has been repressed through the training in the military, conditioning the troop to take up the fight portion leaving a proclivity for violence without a concern for personal safety. To engage in a mortal fight with the enemy this schema spells out the actions in a given situation without becoming preoccupied with survivability in the moment which could get a soldier killed.

 

The warrior with PTSD has grown accustomed to the value and belief systems of war and feels threatened when they become faced with having to let go of this security in an attempt to reintegrate back into society. Howell describes animal defensive and posttraumatic biological states,

 

The human animal may have a repertoire of discrete behavioral states that are adaptive to conditions of predation….[t]hese animal defense states may underlie different dissociative parts of the personality….[t]his begins a neurophysiological alarm reaction…[and]…a tendency to over read cues as threatening, which can increase the probability for violence (p. 29).

 

The ambiguity inherent in social dynamics can lead to mixed feelings or even a lack of feelings depending on the degree of interpersonal relatedness to the returning combat veteran (RCV). We rely on our parental figures to shape healthy personality and values structures through attachments with significant others, the attachments become avenues of exchange, a distillation of proper interactions and expectations according to society norms. When this exchange becomes distorted to the point of the child becoming a repository of negative energy, instead a healthy exchange solidifying proper boundaries, then the nature of our attachments may become warped and disorganized further compounding the RCV’s reintegration.

 

The combat attachments born of blood do not leave us because we depart the battlefield; they become an empty feeling inside of us. The soldier develops a highly narrow functioning self-organization in conjunction with his or her other squad members. This organization, "troop-organism," becomes an extension of the combat-self, no different than an arm or leg. We do not will our arms or legs to move, we react from the expectations of intentional imagery based upon the combat values structure. It happens, such as the members of the "squad-herd" where each part of the troop-organism and acts in a homogeneous way, each troop becoming part of the others self-states.

 

These attachments to the other require a splitting within the interpersonal self-states where many such dissociated selves birth into existence, as each of the value system constructs do not match and out of necessity, develops into a complete compartmentalized persona while maintaining the "whole" sub-self organizations. Each of the self-states run parallel to one another and have the capacity of switching back and forth when the proper situation requires appropriate specialized skill sets. The interpersonal self of the civilian self becomes supplanted and filed away by the combat self due to the incompatibility of the value structures for survivability that requires a conforming from a civilian society to the norms of the combat environment.

 

Attachments can be considered the path to rigidity or vehicles of spontaneity; to become spontaneous the person must develop a mechanism for the free exchange of intimacy through beneficial interpersonal skill sets. Without a healthy development of attachments then disorganized attachments (d-attachments) form. The d-attachments become the mechanism to gauge interactions in the environment and in doing so they become rigid, an if this then that experiential existence. The d-attachment arraignment only allows for what can be controlled under a series of contingencies plans, or procedural knowledge, usually modeled after our parental attachments, an identification with the aggressor or other such negative role model. Becoming an identity of an exclusionary “personal culture” where the individual becomes estranged from regular society and defending their boundaries as they were national borders between two hostile countries (Howell, 2005; & Lee, 2006).

 

The cycle of procedural enactments play out in significant others that we allow in our lives, the reason why we keep having the same dramatizations and arguments while never finding a resolution. We enact our past roles and project them into our relationships cast from our childhood in an attempt to resolve the attachments constructively. Since we have not been shown healthy attachment enactments we reside in the cycle of d-attachments and further compound our disorders through retraumatization and or neglect, predisposing the person to develop trauma based disorders and or personality disorders (Howell, 2005).

 

Without a reintegration of the self and of attachments and d-attachments, a combat veteran can and will run afoul of friends, family and society. The returning combat veteran faces hurdles that they have not been trained to handle, the training and experiences they have navigated and survived will lead them to think a civilian life will be easy compared to the battle life. What they fail to realize is that they have replaced their civilian self with an operational combat value system and attachments, where in American society the individual has the utmost consideration further combining and compounding issues of integration. Little concentration on developing healthy attachment systems the untenable situation can lead the RCV with severely dysfunctional interpersonal skills and a mechanism of perpetual isolation.

 

Indoctrination

Combat alters and modifies the value system, a preconditioned set of beliefs, entailing a value-orientated constitute of definitions of situation in terms of direction of solutions and action dilemmas, formulating a culture of killing, stripping the combat vet of the niceties that lubricate society’s interactions, which in combat would result in death. In combat the fluidity of boundaries becomes awash in the relational adaptation to an integral cohesion with their battle buddies, a devolution of survival mindset develops and provides a sense of safety; the germination of base natural selection process by successful integration of the combat value system. With a disproportionate 56% of Army veterans incarcerated, the Army culture seems to generate people more prone to violence (USDJ, 2004).

 

The war zone recons the birthing of the “trooper organism,” where the firing squad becomes integrated with one other with a culture of survival. The individual boundary of the soldier submerges within the organismal boundaries of the trooper organism while shedding the individual identity. The troop organism allows for the diffusion of immense responsibility over all involved making the transition to an evolution of survival more manageable wherein the herd mentality brings forth the primitive instinctual remnants and the decentralization of obligation. Military culture portrays the combat arms military occupational specialty (MOS) as having more cultural capital and esteem. The infantry MOS with combat decorations increases the rate of promotion, rank and respectability while non-combat soldiers tend to be overlooked (Lee, 2006; & Howell, 2005).

 

Situational Imprisonment

Military enculturalization subsumes CVT into an identification born of survival and dependant on the assimilation of the “firing squad mind set”, where one troops thoughts relates to an extension of his battle buddies. The fluidity of boundaries births the “troop organism” and forever impairs the RCV to return home without his “other selves.” Now the RCV has to try and interrelate without his relational attachments and attempts to reintegrate back into the civilian world where nothing makes sense anymore, where boundaries cross without attachments as a normative experience triggering perceived threat-states. This leads RCV to become his own “isolated island organism,” or an identity incomplete without the other part of the firing squad, that thinks, feels and acts as they do. The RCV becomes unable to interrelate with family and community in a meaningful way, impeded by the fluidity of boundaries.

 

As their safety has been compromised, a feeling of abject detachment has arisen from the conditioned reality of the combat organism that depended upon the battle buddy “having his back.” Therein leading to a sense of safety, the combat vet needed only to worry about their own personal “line of sight” in a battle field environment requiring a 360 degree threat radius. On his own in society this burden becomes an impossibly overwhelming sense of danger engulfing the RCV, leading to a susceptibility to triggers. A culture of 360 degree radius in the battlefield and shackled intimately with the culture of combat values, hereinto relying on the troop attachments and the evolution of survival, the RCV becomes stuck on the troop-organism functionality.

 

The troop-organism capacity becomes problematic to the integration of the “civilian-self” as it now has become supplanted by the “combat-self.” An attachment of the self to the self that is the identity of one whom sufficiently succeeds in suffering, completing the veteran and familial rift. The fluidity of boundaries in an intimate relationship with a loved one becomes a threat to the RCV due to the misidentification of signals between the two, one having adapted an independent perspective and the other a dysfunctional dependent state. The crossed-signals of the significant others has complicated the adaptation from independent relational skills verses over dependence and the perceived threatening self states with both parties expectations of returning to “the way it was.”

 

Compounding the issue, the RCV has now been conditioned to the “culture of killing” and the relational fluidity of boundaries between the two have become incompatible, further given rise to the RCV’s sense of threat as he where in combat. In combat a registering between non-compatible boundaries would be reconciled by a reflexive reactionary exercise of survival, triggering the culture of killing (Kirmayer, Rousseau, and Lashly, 2007). “Those supporting the use of culture as a defense argue that is it intrinsically unfair to judge someone exclusively by the rules and values of a society that he or she does not know” (p. 98). The above goes to the creation of a Veterans Court, where culture competency would require a special understanding of combat vets cultural “shaping.”

 

Criminal Behavior, Context and Responsibility

“[T]rauma exposure and symptoms of PTSD are prevalent among incarcerated veterans….[e]xposure to combat was the trauma most likely to lead to PTSD among males in a general population survey of 5, 877 individuals, [totaling] 19 percent” (Saxon, A. J., Davis, T. M., Sloan, K. L., McKnight, K. M., McFall, M. E. & Kivlahan, D. R., p. 962, 2001). Saxon et al. indicated a higher prevalence for PTSD in incarcerated veterans than the general population. Additionally veterans who screened positive for PTSD had significantly higher numbers of childhood trauma, indicating a possible correlation between peritraumas, military culture and past traumatization.

 

Taking culture into account means that the purposes of the criminal justice system—which include prevention and rehabilitation—can be achieved more effectively. Cultural awareness must be coupled with an equally astute political awareness that traces the consequences of clinical or forensic consultations out into the larger society (Kirmayer et al., 2001, p. 101).

 

Before the Insanity Defense Reform Act of 1984, questions of the “ultimate issue” when a defendant pled insanity in federal court was whether he lacked “the substantial capacity either to appreciate the wrongfulness of his conduct or to conform his conduct to the requirements of the law” (As cited in Buchanan, 2006, p. 14). After the bill was enacted, the question now goes to whether he “appreciated the nature and quality or the wrongfulness of his acts” (p. 14). “Case law and the Rules’ legislative history suggest also that in less clear cases an issue’s ‘ultimate’ status hinges on who has the authority to decide it….because it amounted to an ‘ultimate opinion’” (pp. 14-15). Psychiatric expertise falls under the Civil Procedure Rules (CPR), Part 35, whereby the duty of the assessor, in an expert capacity, is to help the court. A mental defense with the question of competency will rely on the weight of cognitive capacities.

 

With our modern soldiers averaging two to three tours of combat, we will begin to see an increasing epidemic of incarcerated veterans. In the next 10 to 15 years the American public will see a sharp rise in veterans suffering from Post-Traumatic-Stress-Disorder, to the point of epidemic proportions. You see, never before in war have our troops been subjected to such prolonged exposure to combat and life threatening situations. In World War II our troops were fighting a defined enemy while engaging real objectives with sufficient downtime in between engagements. Most of the troops to see combat were infantry soldiers fighting on a distinct front, not the ones "in the rear with the gear". With a real threat to our sovereignty and way of life soldiers of this era were less affected by the trauma of war.

 

The significant political interference of the Vietnam War generated little to no tangible objectives for our soldiers solidifying and branding their levels of anxiety and forever troubling their minds. Guerrilla warfare, an inherently cognitively damaging military action compounded the neuropathic damage experienced by our troops in Vietnam. Even with the troops having regular downtime in between engagements the cognitive fractures of these veterans were enhanced by more intense combat and the rejection of our returning soldiers.

 

The soldiers in the Iraqi war have been sent on multiple deployments with an average of two or three tours of duty with little time in between. While in Iraq, there are no friendly countries or areas to spend leave time to relieve stress while residing on constant alert and most, even non-combat soldiers, see combat or threats on a daily basis. Now combine this with the most intensive warfare possible, guerrilla warfare in an urban environment. We get troops that are overextended and overexposed to life threatening situations within unprecedented levels of combat. Our troops in Iraq have no respite from danger, further entrenching the effects of PTSD through the hyper levels of neurotransmitters (Lee, 2008).

 

Dissociated attachments reenact combat trauma somatically and between interstates within the RCV resulting in a “civil war” amongst oneself. A seemingly supra-intelligent guidance of the unconscious, this device of PTSD that engages in the survival defensive mechanisms that has sustained the combat veterans life on a persistent basis. Thus becoming the protector and a “conceptualization of hostile self-states in ‘personified narcissistic and sociopathic defenses’ that defend against dependency, vulnerability, and guilt…[and]…applies just as well to pathological narcissism” (Howell, 2005, p. 224). The ‘diminished capacity’ rule would apply when dissociative episodes result in a “psychotic” break, whereby a thought disorder could be ascribed.

 

Diminished capacity resulting in a thought disorder would be split between two categories; one being “disturbances in the content of thinking and perceiving (hallucinations and delusions), and… [the second would be]…disturbances in the form of thinking (formal thought disorder)” (Young, 2003, para. 7). Procedural memory becomes disengaged from experiential memories where reactionary encoding enables the maladaptive somatic response encoded reactions needed during survival in the moment situations. Multiple self-states dissociate and boundaries within boundaries abound.

 

I am just now starting to sift through the sea of case law and journal articles on the considerations of PTSD and criminality; unfortunately I think that there will be an ever increasing need for individuals well versed in the pitfalls of combat trauma and difficulties in reintegration. I feel as you do that something needs to be done to address this issue head on, such as a Veterans Court much like the one just established in Minnesota. Additionally, we have only begun to see the tide of returning veterans with psychological troubles facing criminal charges.

 

Never before in the history of American warfare have we seen such high numbers of soldiers who have been under unimaginable stress. In WWII 18% of our soldiers actually engaged in combat, with Vietnam it was 30-40%, today 68% have actually engaged in combat (Veterans for common Sense & Veterans United For Truth, Inc v. Veterans Administration, item 54, & National Center For PTSD Fact Sheet, Aftermath of Violence section, paragraph 2). Not only have more soldiers engaged in combat, they have been in combat longer with an average of 2 to 3 tours of duty. Many have been on 5 tours and some as much as 6. As high as 80-90% of soldiers (Hoge, C. W., Auchterlonie, J. L., & Charles S. M., 2008, results section, paragraph 5) have seen someone get killed, or been in a combat zone, we have reached "Combat Saturation."

 

Today 15% (300,000; Rand Corporation, 2008) of our soldiers and veterans have been diagnosed with PTSD and this seems like it may be a smaller number compared to other wars. 30% PTSD rates in Vietnam, 15% estimated in WWII and 15-20% of Gulf War I vets reported to have PTSD. It took Vietnam veterans up to 10-20 years before their symptoms reached the point of becoming debilitating. The implications for our modern veterans will have monumental deleterious effects in the next 10 years, it has been projected that PTSD rates in today's wars will reach 50-60%. We will be inundated with mentally ill veterans who have few options and nowhere to turn and they will run afoul with the law (Lee, 2006).

 

Today we have become faced with a growing trend of soldiers and veterans becoming enmeshed in the court systems. In direct conflict with the perception in the media I propose the theory that our veterans and soldiers face an insufficient mental health care which has a major impact to their lives, families and communities. The problem is not individualistic but systemic requiring major changes in how we view and treat PTSD. The care of our soldiers and veterans is not being met and we have just begun to see the aftereffects of the mind shattering results of combat trauma. Untreated PTSD can destroy the lives of many, not only the soldier and veteran. We send our soldiers to war for our freedom and then lock them up when they are broken and of no use anymore (Lee, 2008).

 

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References

Appelbaum, P. S., Jick, R. Z., Grisso, T., Givelber, D., Silver, E., & Steadman, H. J. (1993). Use of posttraumatic stress disorder to support an insanity defense [Electronic version]. American Journal of Psychiatry, 150(2), 229-234.

 

Brook, T. V. (2008, August 12). Report: 57% of troops sent on combat tours. USA Today. Retrieved October 12, 2008, from http://www.navytimes.com/news/2008/08/gns_deployments_081108/

Bourget, D., & Whitehurst, L. (2007). Amnesia and crime [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(4), 469-480.

Buchanan, A. B. (2006). Psychiatric evidence on the ultimate issue [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 34(1), 14-21.

Cercone, K. (2006). Brain based learning. In E. K. Sorensen (Ed.), Enhancing learning through technology (pp. 293-322). Hershey, PA: Information Science Publishing.

Congressional Research Services (2008). United States military casualty statistics: Operation Iraqi Freedom and Operation Enduring Freedom. CRS Report RS22452. Retrieved on October 29, 2008, from http://assets.opencrs.com/rpts/RS22452_20080909.pdf

Hoge, C. W., Auchterlonie, J. L., & Charles S. M. (2006). Mental health problems, Use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan [Electronic version]. Journal of the American Medical Association, 295, 1023-1032.

Howell, E. F. (2005). The dissociative mind. Hillsdale, NJ: The Analytic Press.

Kimayer, L. J., Rousseau, C. & Lasley M. (2007). The place of culture in forensic psychiatry [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(1), 98-101.

Lee, S. A. (2006). Effects of combat on returning veterans. Unpublished manuscript, Jefferson Community and Technical College at Louisville Kentucky.

Lee, S. A. (2008). Combat veterans and institutions: A systems analysis. Unpublished manuscript, Kent School of Social Work at the University of Louisville.

National Center for PTSD. (n. d.). The unique circumstances and mental health impact of the wars in Afghanistan and Iraq. Retrieved December 23, 2008, from http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_iraqafghanistan_wars.html

Mezey, G. (2006). Post-traumatic stress disorder and the law [Electronic version]. Psychiatry, 5(7), 243-247.

Poortinga, E., & Guyer, M. (2007). Criminal responsibility and intent [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(1), 124-125.

Powers, R. (2005). Deployment rates, United States military. About.com. Retrieved on December 26, 2008, from http://usmilitary.about.com/od/terrorism/a/deploymentrates.htm

Rand Corporation (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Retrieved December 23, 2008, from http://www.rand.org/pubs/monographs/2008/RAND_MG720.pdf

Robinson, C. L. (1999). Observations on cognition and insanity [Electronic version]. American Journal of Forensic Psychology, 17(4) 63-75.

Saxon, A. J., Davis, T. M., Sloan, K. L., McKnight, K. M., McFall, M. E. & Kivlahan, D. R. (2001). Trauma, symptoms of posttraumatic stress disorder, and associated problems among incarcerated veterans [Electronic version]. Psychiatric Services, 52(7), 959-964.

Young, D. W. (2003). Varieties of thought disorder in the criminal context. Washington State Bar Association. Retrieved October 29, 2008, from http://www.wsba.org.media/publications/barnews/2003/mar-03-young.htm

United States Department of Justice. (2004). Veterans in state and federal prison system, 2004. Retrieved November 20, 2008, from http://www.ojp.usdoj.gov/bjs/pub/pdf/vsfp04.pdf

Veterans for America (n. d.). Talking points: The consequences of churning & weekend warriors to frontline soldiers. Retrieved October 29, 2008, from http://www.veteransforamerica.org/wp-content/uploads/2008/04/talking_points.pdf

Veterans for Common Sense & Veterans United For Truth, Inc v. Veterans Administration, C-07-3758-SC, 2007 U.S. Dist.

 

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(To come...Scott's guide to dealing with PTSD and the law for veterans and their loved ones, linked here.) 

Projects Target PTSD-Related Relationship Aggression

"Living with posttraumatic stress disorder (PTSD) can strain any relationship—sometimes to the point of violence against a loved one. University of Arkansas psychologist Matthew T. Feldner, Ph.D., is part of two national research projects aimed at preventing relationship aggression in couples coping with PTSD and treating this type of aggression when it has already developed.

“The main aims of these projects are to reduce the number of new cases of interpersonal violence and reduce the number of cases already existing,” Feldner says. “We teach couples skills for better relationship behaviors, such as how to communicate better and how to manage anger.”

All people receiving these interventions will be closely monitored and referred for more intensive individual therapy should the need arise. Rather than going back to focus on the roots of the PTSD, Feldner says the couples in these interventions “will focus on the here and now of how the PTSD is affecting their relationship.” While teaching couples about the features of PTSD and improving their relationships, the group treatment can also serve as a gateway to further treatment for PTSD and other services.

If these interventions succeed in preventing or treating relationship aggression, Feldner says that these would be groundbreaking, landmark projects. “Ultimately, we are hoping we can conduct these interventions in such a way that they could be useful for the VA and could be extended to community populations as well, for situations that are not specifically military,” Feldner says."

— Source: University of Arkansas, Fayetteville

In the News: Two Articles Worth Reading Recently

Two articles worth reading that have been in the news recently:

"How the VA Abandons Our Vets," by Joshua Kors, in The Nation, linked here; and the poorly-headlined but otherwise worthwhile"Military Town Newspaper Challenges U.S. Military on Murder of Military Women," by Ann Wright, in TruthOut.org on the Web, linked here. 

Kors' article talks about the recent veterans' class-action lawsuit against the VA, fought in Federal court, and WHY it was necessary -- and there are some interesting and unexpected points, which didn't show up elsewhere in enough detail.  The biggest one is about the "fuzzy math" the VA employs to calculate claim times, and how this uniformly works against veterans (no pun intended on the "uniformly" thing.) It also confirms a longheld impression on my part that a veteran who struggles intensely with the mammoth difficulty of being his or her own advocate in the process, and ends up committing suicide, is actually counted as a "victory" for the VA, who calls their claim "resolved" in the time it took them to kill themselves.  In other words, fellow veterans killing themselves while waiting for their claims to be resolved actually makes the VA look "better and faster" at resolving claims, if you can believe that.  Yikes.  Talk about a system that needs to be overhauled and addressed...

Another great point Kors makes is that "someone" already attempted -- but was fired for her efforts.  That "someone" is Frances Murphy, M.D., who in 2004, according to Kors, "helped draft the Mental Health Strategic Plan, a blueprint for overhauling the VA.  The plan called for 256 changes to the organization, among them: installing a tracking system to stay in touch with suicidal veterans, creating rehabilitation programs that involved veterans' families, and streamlining the benefits process to resolve wounded veterans' immediate needs."  However, after expressing her frustration in public (to mental health providers) about the barriers the VA erects to veterans' speedy care, and how this causes veterans to suffer additionally and unnecessarily -- she was summarily fired.

Read the Kors piece to understand what wounded veterans have to go through, and how unfair it is; and to get a better picture on the fuzzy math that's employed to make things seem much better than they are.

The Ann Wright piece talks about military wives and women servicemembers murdered recently by other servicemembers, and mainly serves to remind us of how this is a problem that isn't going away.  The "news peg" for her article is a recent editorial in the Fayetteville, NC Observer -- Fayetteville is close to huge Army and Marine bases -- called "Our View: Military Domestic Violence Needs More Aggressive Prevention" (speaking of odd word choices).  That editorial is linked here.  The editorial references a recent vigil to memorialize the murdered women locally.

In conjunction with the Helen Benedict material and the other writings on Military Sexual Trauma, blogged about recently, here -- this is a topic worth keeping in the forefront of our minds.  Collateral damage from combat trauma? Or just crimes committed by otherwise sick individuals who happen to be in the military?  Either way, "more" needs to be done about this terrible problem.  (A similar and related topic is the "non-combat deaths" one we discuss from time to time, which can sadly be what's used to describe what more actually is a victim's suicide or a "domestic violence" type murder, of one servicemember by another.) We're just about to add a series of blog posts about domestic violence, and why it's important to leave when you're at risk, but ideally how to do so in a way that preserves your life.  Look for that shortly.

About the authors:

Joshua Kors is an investigative reporter for The Nation, where he covers military and veterans' issues. He is the winner of the National Magazine Award, George Polk Award, IRE Award, National Headliner Award, Casey Medal, Mental Health Media Award, and the Military Reporters and Editors Award.  He was also a finalist for the Michael Kelly Award, Tom Renner Award, Harvard's Goldsmith Prize for Investigative Reporting, and the American Bar Association's Silver Gavel Award.

Ann Wright is a retired US Army Reserves colonel with 29 years of military service. She also was a US diplomat who served in Nicaragua, Grenada, Somalia, Uzbekistan, Kyrgyzstan, Sierra Leone, Micronesia and Mongolia. She is the co-author of "Dissent: Voices of Conscience," profiles of government insiders who have spoken and acted on their concerns of their governments' policies.

Twice Betrayed: Women Veterans and Military Sexual Trauma

It's my deep-seated belief that women veterans who suffer military sexual trauma risk being twice betrayed: once by their perpetrator in uniform, once by the system itself, which should be doing a much better job of protecting them from a problem that's too apparent, widespread, and part of the actual culture to pretend that it doesn't exist.

 

See Jeff Benedict on this:

"But an occupation that thrives on a unique capacity for aggression among participants runs the risk of being a home for troubled men who cannot contain their rage against the opposite sex." -- Jeff Benedict, author of "Public Heroes, Private Felons"

Preventing Psychological Injury, Betrayal and Trauma: The Real “Costs” and “Treatment” of Military Sexual Trauma

 

Sometimes I think I miss the point on some of these blog posts: I’m too busy trying to set the stage and establish the “milieu” so that a thoughtful person can absorb it all and come away with a new outlook or two on a “same old” problem.  But maybe I’m failing to come right out and say what I’m really thinking, and God knows enough people are floundering around on this topic who shouldn’t be, so maybe I just will.  Here goes the suddenly editorial portion of our program:

 

We heard Jonathan Shay, M.D., Ph.D., pretty much the foremost expert nationally on veterans and PTSD, talk the other day about the “psychological injury” that troops are exposed to from lack of sleep, before and after combat, and how that sets them up for significant problems.  True; agreed; understood.  What we’re talking about here with women in the military and military sexual trauma is a similar thing: preventing and treating what is a grievous psychological injury. It's a situation like the one Shay talks about, something where the proverbial “ounce of prevention” is worth the “pound of cure.”  Shay is remarkable: he’s one of a kind.  There’s probably no better advocate for veterans in the country, although anyone who works with veterans from the heart is worthy of great honor.  It’s a pretty much unsung, undervalued calling.

 

However, we can’t really expect Dr. Shay, as amazing as he is, to come out and have much to say about military sexual trauma.  He’s got his hands full already with what his topics are; and, his main “demographic” has always been Vietnam veterans, most of whom…the vast majority of whom…are men.  That’s who served for the most part in Vietnam. That is not the composition of the military today; or even the contracting world that “supports” (using that term somewhat loosely) the military and the Department of Defense.

 

So we need to find some new experts, and some new paradigms; put in place some new safeguards, establish and deliver some new training; and, in general, get a radically new “outlook” on this problem.

 

That’s why I bothered to link in the passage from Jeff Benedict’s book about pro athletes who commit crimes against women, and how they are protected, in part, by the very environment in which their crimes take place.  So too with the military: it’s as good an analogy as you’re going to get right now, and frankly, we’re in need of one.

 

It’s a crying shame that women victims of military sexual assault are being murdered (they are) by their perpetrators to prevent their coming forward; and killing themselves (they are) because they’ve anticipating a double betrayal: the military that failed to protect them in the first place – and allowed the assault to happen – and the betrayal they expect to take place, when they muster up enough strength, courage or hope to try to “fight the system” and report the crime.  In the clutch – feeling desperate, forsaken and very much alone -- some of these women just give up, and take their own lives, because they’ve so lost hope that the system will get them the justice they deserve.

 

If you read the literature on suicide – something that plagues veterans with PTSD, and military sexual assault causes and is associated with PTSD in women – it’s not that hard to see the link.  People kill themselves when they give up hope; and when they anticipate from looking around that their situation isn’t going to be handled any better (any more sensitively, well or effectively) than the last person they heard about who had the same issues.

 

Listen to a world-renowned expert on suicide, Edwin Schneidman, for a moment on this.  A person goes from being troubled (perturbation) to doing something final about it (lethality) when they give up hope.  "Lethality, when coupled with elevated perturbation," writes Schneidman in his book, The Suicidal Mind, "is a principal ingredient in self-inflicted death.  Perturbation supplies the motivation for suicide; lethality is the fatal trigger."  He continues:

 

"Lethality -- the idea that "I can stop this pain; I can kill myself" is the unique essence of suicide.  Anybody who has ever switched off an electric light deliberately to plunge a hideous room into darkness or, with equal deliberation, stopped the action of an annoying engine by turning the key to OFF, has, for that moment, been granted the swift satisfaction the suicidal person hungers for.  After all, the suicidal person intends to stop the ongoing activities [including their highly personal traumas] of life."

 

What's the relationship to this topic?  Do I need to make it explicit?  Well, then, I will: if you set people up in a situation where they will fail (be assaulted) and then furthermore not address their condition compassionately, seriously, effectively or well -- the torment they feel (perturbation) is enough to create a sense that there is truly "no way out" (lethality) and no one who cares.  I think we have all the ingredients here.

 

Said another way, let's turn to Kathie Costos.  Chaplain Kathie Costos, who’s been caring about PTSD issues and the military for years now, signs her personal emails with a great quote, allegedly from George Washington.  It says:

 

"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

Well, let’s just snap our fingers and bring that comment current, collapsing it with the material we’re talking about right here.  It still applies:

 

“The willingness with which women who have suffered sexual assaults in the military are to come forward is directly proportional to how they perceive other women veterans who have been victims of military sexual assault have been treated.”

And it seems they would have good reason to be concerned. You see women who came to horrible ends because their predation wasn’t understood for what it was (Maria Lauterbach and Cesar Laurean, but there are plenty more cases like that in the news, not just them); those whose situation was wrongly classified as “suicide” when it was way more clearly murder (see the case of Army Private LaVena Johnson, profiled in Salon and elsewhere, linked here); outrageous sexual assault situations against women contractors (see Jamie Leigh Jones' allegations against KBR, linked here); and well, the list goes on and on. Justice delayed = justice denied. 

 

It's just human nature/common sense: Fewer women come forward to report problems when they can see that the last situations they knew about weren’t handled well by the overarching authority, the military, and represented just more hell for the women involved.  That seriously needs not to happen.

 

(The Sacramento Bee, following up on my lifetime theme about good journalists pushing the culture forward, recently completed an exhaustive, and interesting, investigation about troops with criminal backgrounds, and what the effect on their subsequent service is.  Unfortunately for our purposes it didn't go far enough, because it didn't highlight or single out crimes against women.  If that were studied, and the results were significant -- that's two "if's," we realize -- those findings could go towards screening those potential recruits out of the military.  In a highly-charged aggressive environment with lots of boredom and little oversight, the last thing someone needs is more sexual predators in the midst, in uniform.)

 

In general, though, the focus shouldn’t just be on “reporting” or “treating” women who have suffered military sexual trauma.  It should be on prevention primarily, with a secondary emphasis on the others – or a sense that together, all three of those cords braid into a very strong rope, the kind that women will need to pull themselves up out of a very bad situation.

 

Women who suffer military sexual trauma are twice betrayed: once by the rapist, once by the system.  It’s time to put an end to that problem.

 

Some recommendations?

Create an atmosphere in which military sexual assault is not tolerated.  Where prosecution is expected and justice is swift.  Take women’s concerns seriously.  Raise the standard of investigation and prosecution to be on a par with the civilian world.  Expect, demand, and reward parity with the civilian police departments (good ones) and criminal justice system on this topic.  No more lost rape kits or botched, semi-competent investigations.  If you don’t know how to do this, go learn from the people who do, in the civilian world.  Call them in to be your speakers at your conferences, not the dipsticks who can simply restate the problem to you and offer nothing more than singing “Kumbaya” together as a solution. If you don't have the experts in-house, and my guess is that you heavily don't, go find them, because they are out there: many are specialists in a parallel situation in the civilian world. 

 

Call in some cutting edge thinkers, who can help you re-evaluate the situation as it already stands, and think some new thoughts on it.  People who have some competence in the civilian world, and are sensitive to the issues and concerns that surround women who have been traumatized by aggressive men in a culture that rewards it, but can’t seem to manage mitigating those qualities when they’re not called for – off the field.  The closest analog is actually pro sports: and both Jeff Benedict and Victoria Vreeland (incidentally, both attorneys) who we wrote about the other day on this, if they’re willing, might have copious insights to provide, based on their work with women who have been traumatized by sexual predators.  (Heck, I even know of one combat veteran and ex-cop, ex-police chief, ex-criminal justice teacher, who's getting his Ph.D. in psychology, and intimately understands PTSD, because he has it from combat. He might be willing to help you think through the problem, and create some solutions: or help train the trainers.  That's Rob Honzell.)

 

Want to know the scope of the problem?  Listen to Paul Reickhoff on it, who is once again pushing for change in a key area of importance to veterans.

 

Want to learn how to screen for potential offenders, or protect and keep women secure from it? Get in touch with Gavin de Becker, author of The Gift of Fear, and Protecting the Gift, and have him talk to you about what better security looks like for people who need the assist (women) in a dangerous environment.  A senior consultant to the Rand Corporation, and an international expert on security and threat assessment, he’s very familiar with concepts like unwanted pursuit, and predicting violent behavior – two topics that ought to be of concern to the military infrastructure on this problem.  Thankfully, he’s also very sensitized to the whole topic of women and assault, which is a rarity. 

 

Want to learn how the law and the medical system can work in conjunction to intervene effectively, and bring hope back to survivors?  Study things like the innovative “Passageways” program, a medical-legal partnership between Harvard Law School’s Legal Services Center and Boston’s equally eminent Brigham & Women’s Hospital that offers domestic violence intervention for women. Sarah Boonin is the person who knows most about this program: her bio is linked here. (The Passageways program even has a cool little book that might be helpful for survivors as they work through some of their issues.)  And spend some time thinking about how to keep women warriors safe in an environment where their sexual safety is a) not a priority, and only poorly understood as a need; and b) where prosecution and treatment of offenses can be poorly handled, botched, or doubly victimizing.  Enlarge your minds, call in the real experts, not the supposed experts, ask the good questions, shake up the paradigm; rethink the problem, and come up with better solutions.

 

As good ol’ Albert Einstein is alleged to have said, in some vague quote I’m botching as I paraphrase, “no real problem can be solved at the same level of thinking that was in place when it was created; you always have to go one level up from it.”

 

That is…if you really want it to be solved.

 

It’s always possible – we like to look at every side of a topic, to better understand the 360 of it – that really nobody wants to solve this problem, or they’d be doing a better job of it.  Is it a way to shuffle women out of the military, which some feel they never should have been a part of in the first place?  Would it take too much wise screening of potentially felonious recruits, to start cutting down on the types of potential predators who are donning uniforms?  Is the longtime military focus on just one aspect of “flipping the switch” – the switch that trains men to be killers, but doesn’t help them re-integrate after combat, and resume their ordinary lives – part of the problem?  Men in combat are a finely-tuned killing machine, with women warriors in their midst – and the whole psychology is attuned to the enemy as the opponent.  Sometimes, women inadvertently become the opponent as well.

 

Seriously – who knows?  Certainly not I.  But one thing I do know for sure: this situation cries out for better handling.  And every week that goes by that it isn’t, women are being assaulted, dying and being killed – at their own hand, and at the hands of others.  And worst of all, by the system’s neglect.

 

It’s great that they’re out there – VA programs like the National Women's Trauma Recovery Program for Women Veterans, which we've blogged about here, and the Women's Mental Health Center for Women Veterans, which we've blogged about here -- programs devoted to helping women heal from military sexual assault.  But those programs are in their infancy, there aren’t enough of them, and the women who suffer these invasive tragedies and horrors by those with whom they serve – have a hellaciously tough time putting their lives back together again.  It’s in their honor that I’m even talking about this, which is a little off the topic of the main theme here on this blog, combat trauma and PTSD.  Really, though, military sexual assault of women warriors is just “another form of combat trauma.”

 

In wartime, “betrayal,” which means to have trust broken by one of the parties, in a horrific way that affects the one who relied upon it, and causes them by implication great harm – is a called “treason” – a crime punishable by death.  That is, when it’s the servicemember betraying the military.  When it’s the military betraying the servicemember?  What do we call that?

 

Let’s hope what we don’t call it is...business as usual.