Healing Combat Trauma

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.

43,000 Troops Found "Unfit to Serve": Non-Deployable but Sent Anyway?!

Several weeks ago I watched a wonderful Bill Moyers interview on PBS with Oliver Stone, noted filmmaker and Vietnam veteran. The whole interview was great, but a figure Moyers used at the beginning was just stunning -- for the implications it has for soldiers with PTSD and their families.

Moyers said:

"...I read a report based on military records which revealed that from 2003 to 2008 some 43,000 troops had been sent to Iraq and Afghanistan despite having been classified as "non-deployable" for medical reasons. In plain English, they weren't healthy enough to go, but were sent, anyway."

Yowser. It's hard to imagine a circumstance in which being considered unfit to serve for medical reasons, and being deployed anyway, improves your situation. It sounds like all it would do is reinforce the difficulties you were already having, or pile more trauma on top of the pre-existing trauma.

Additionally, troops who have fought in Iraq, when they're deployed next to Afghanistan, find that to be a completely different experience. So Afghanistan for them isn't "more of the same," it's new and different, with all the challenges that implies.

(See news report from November 29, 2009, entitled "Afghanistan, Iraq: Different Wars -- U.S. Soldiers: Afghanistan War Dramatically More Difficult, Challenging Than Iraq," linked here.)

Editor's Note: For the link to Bill Moyer's Journal and his excellent interview with Oliver Stone, shown on December 4, 2009, click here.)

"Love Shouldn't Hurt": Combat Veterans, PTSD, and the Deadly Serious Topic of Domestic Violence

Domestic violence is an enormous public health problem in our society today. Domestic violence among families of combat veterans is also a significant problem -- if you take "significant" to mean, "important to those it affects." According to a fact sheet produced by the National Center for PTSD (NCPTSD), part of the VA, domestic violence is "the most frequent cause of serious injury to women, more than car accidents, muggings, and stranger rapes combined."

Among veterans, studies show that "domestic violence rates among veterans with post-traumatic stress disorder (PTSD) are higher than those of the general population. Additionally, according to studies, domestic violence rates among "active-duty military men (Heyman & Neidig, 1999), couples seeking relationship therapy (O'Leary, Vivian, & Malone, 1992), and Vietnam veterans with and without post-traumatic stress disorder (PTSD; Jordan et al., 1992) have been found to be higher than those from the general population." 

One academic paper adds, making a crucial point, "Research has yet to study couples seeking relationship therapy in which the veteran has PTSD to explore how these relationships compare with other couples. Given the elevated risk for violence among these couples due to the PTSD, the treatment-seeking behavior, and the relationship distress, couples seeking relationship therapy are an especially vulnerable population." (And of course, couples not seeking relationship therapy might be even more under-served -- it's just they can't be as easily surveyed.)

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Casey Taft, M.D., an associate professor of psychiatry at Boston University, has recently been awarded a $1.5 million grant from the Department of Defense to study this topic. From an article published by BU, announcing the grant, quoting Taft, and linked here:

"People who are exposed to trauma, and in particular those who develop PTSD, are at very high risk for aggressive behavior,” says Taft, who also works at the Boston Veterans Affairs Medical Center and the National Center for PTSD. “In one Vietnam war study, they found that among vets with PTSD, one third had engaged in physical violence against their partner in the past year. This rate was almost three time the rates they found among vets without PTSD. Since we know that current vets in Iraq and Afghanistan have been exposed to significant trauma and many of them have been on multiple deployments and they’re coming back with high rates of PTSD and other mental health issues, it would stand to reason that they would also engage in high levels of aggression and partner violence, though we don’t have the specific data to back that up.”

(Hence the study).

In the meantime, know that domestic violence can be "deadly serious."

Domestic violence is serious. Risks include death, serious physical injury, and psychological injury as well -- including PTSD and secondary PTSD. Just some of the psychological effects (often less obvious initially than the physical effects) are: depression and being at greater risk for subsequent suicide.

Again, according to the NCPTSD, "60% of battered women report depression," and "25% of suicide attempts by Caucasian women and 50% of suicide attempts by African American women" have been "preceded by abuse."

Some more sobering statistics about the magnitude of the problem:

• 20-30% of American women will be physically abused by a partner at least once in their lifetimes; 
• 30-40% of women's emergency room visits are for injuries due to domestic violence;
  
• 30% of women killed in the U.S. are killed by their husbands or boyfriends;
  
• 50% of men who assaulted their female partners also assaulted their children;
  
• 3.3 million children witness domestic violence each year.
• 1.3 million women and 834,732 men are physically assaulted by an intimate partner annually;
• 201,394 women are forcibly raped by an intimate partner annually;
• 11% of women in homosexual relationships and 23% of men in homosexual relationships report being raped, physically assaulted, and/or stalked by an intimate partner;
• 503,485 women and 185,496 men are stalked by an intimate partner annually;
• 1-25% of all pregnant women are battered during pregnancy;

What to do if you're in crisis?  There's a

National toll-free Domestic Violence hotline: 1-800-799-SAFE (7233)

There's an excellent "Fact Sheet" put out by the NCPTSD, linked here; and

There's a "safety plan pocket guide," linked here.

The NCPTSD's fact sheet, they say, provides "information regarding the definition of domestic violence, the prevalence of domestic violence, the dynamics of abusive relationships, the effects of domestic violence, treatment for victims and perpetrators, and resources offering assistance."

There are also some good resources at other websites, including FamilyOfAVet.com, linked here.

The Vietnam Veteran as Exile: Missing in America, But Hidden in Plain Sight

My friend the veteran artist John Paul Hornbeck made this flag -- I just love it.  It carries forward the whole issue of POW/MIA into the present day, by asking in effect why the veteran is "still" Missing in America (that's the "MIA" part these days.)  He mocked up this flag, using the old and familiar symbol, to highlight the cause of homeless veterans in America -- a cause worth addressing.

I'm broadening the point, though, to something else:

Why ARE Vietnam veterans, in particular, still exiles in their own land?

And what should we, as a country, be doing about that?

Because failing to address that, failing to welcome back these warriors into their own land, perpetuating their exile both from what they've seen/done/experienced and how they were received when they returned -- has left a gigantic, gaping gash in the "fabric" of the American psyche; and decades worth of not addressing it has not resulted in any pain being healed.  Sure there are sporadic attempts made here and there, but they're relatively weak, lackluster, or involve too few people to really make a difference.

If you read Pat's "Welcome Home" story, or Claude Anshin Thomas', just to use the names of two representative Vietnam vets among thousands -- you find out that they are STRIKINGLY similar, almost verbatim copies of each other (and the rest who haven't written them, I suppose).  The hopes, the dreams, the flat-out fantasies (under the circumstances) of how they were to be received -- combined with the completely dashed, rejected and really shattered realities of how they were -- aie, the mind boggles.  It's surprising the whole generation of warriors didn't go postal, not just a few.  It also explains why so many of them are still living in pain to this day.  Turned into exiles by what they lived, that they had no possible means of integrating -- and shunned by the country they fought for.  If that woudn't give you issues, I'm not sure what would.

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So let's think outside the box on this, FAR outside the box.  (If the box is the status quo, that is, because that's not particularly impressive.)  What prevents us from giving veterans, in every city across America, down EVERY Main Street -- a true, genuine, and long-overdue "WELCOME HOME"?!

Couldn't we use that psychic energy we'd gain back as a nation -- from repairing the rent in our actual psyche -- to surge forward, and embrace our combat veterans from here on out, with all the services and the help they so desperately need?  We've seen the problem: it's been well-documented.  But even to go forward successfully, in this case, I think we also need to go backwards -- make use of the "invisible bridge" -- and welcome the group of veterans who are STILL waiting, 40 years out, for America to acknowledge their return.

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I learned a long time ago, that even in personal relationships, there's a big difference between the crappy/weak/self-serving apology -- "sorry IF I hurt your feelings" -- and an actual, gut-level, authentic and genuine apology, that takes responsibility, asks for forgiveness from the injured party, waits for the answer, or renegotiates the situation -- and then moves on, healed.  In the Bible, that's even called the difference between "worldly sorrow" (sorry I got caught) and "godly sorrow" (sorry that I did it, because I know it was wrong).  Without making a point about religion here, I'm merely trying to show that many traditions understand there's a difference between a heartfelt apology, a lame one, and none at all.  It's like the Oliver Wendell Holmes line from a few blog posts back, that "even a dog knows the difference between being kicked, and being tripped over."

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Let's harness or leverage the momentum from the current groundswell of public "enthusiasm" for veterans' rights, exemplified by support for passage of the new GI bill, and the continuing emphasis on not settling for less in healthcare, particularly PTSD and TBI.  Let's expand that, though, to other issues of concern to veterans, before the "mood" passes -- as it surely will -- to be eclipsed by other different, pressing concerns.  Let's settle our largely unspoken national shame with how we treated Vietnam veterans, while a few of them are still alive to appreciate that our apology is genuine, and acceptance would heal us all to be able to move forward.  What we don't want to do is to create two different classes of veterans: the ones we care about, who get the right treatments for the right reasons; and the ones we don't, because we frankly made such a mess of it it's just easier to overlook it than apologize and move on.  It's time to make things right for ALL veterans.  Let's have those Welcome Home parades NOW...

Editor's note: John Paul Hornbeck is the artist (and veteran) who made "Shattered Soldier," the lifesize scultpture of a veteran with PTSD, that we blogged about earlier, here.  He is the child of an American Vietnam war veteran Army father, and a Vietnamese mother.

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.

Would Expanding Awards of the Purple Heart to Include PTSD Help End the Stigma?

A few months ago, a debate began in military and veteran circles that may continue for years: Whether the Purple Heart, traditionally reserved for awarding to those killed or wounded in battle, should be extended to include also "invisible wounds" of battle, like PTSD.  There are no easy answers.

Said an article at the time, in the Wall Street Journal:

"The dispute reflects a broader question roiling the military: Can psychological traumas, no matter how debilitating, be considered equivalent to devastating physical wounds?

Supporters of awarding the Purple Heart to veterans with PTSD believe the move would reduce the stigma that surrounds the disorder and spur more soldiers and Marines to seek help without fear of limiting their careers.

“These guys have paid at least as high a price, some of them, as anybody with a traumatic brain injury, as anybody with a shrapnel wound,” Dr. John Fortunato, who runs a military PTSD treatment facility in Texas, told reporters recently. Absent a policy change, Fortunato told reporters, service members will mistakenly believe that PTSD is a “wound that isn't worthy.”

Opponents argue that the Purple Heart should be reserved for physical wounds, as has been the case since the medal was reinstituted by Congress in 1932. Military regulations say the award should go to those with injuries “received in action with an enemy.” Some opponents also note that PTSD can be faked, which can't easily be done with a physical wound.

“The Purple Heart was meant to be a badge of honor to show you were wounded in battle,” said Bob Mackey, a retired Army lieutenant colonel who fought in the first and second Iraq wars. “I've been in combat three times. There's stuff I've had to deal with. But it's substantially different from being physically hurt.”

Mackey said the biggest difference is that some veterans may be diagnosed with PTSD even if they never saw combat or fought an enemy – requirements, historically, for receiving a Purple Heart."

Military.com also conducted a poll on its website about the issue (see graphic), and only about 1/3 (33%) of the respondents voted "yes" to awarding the purple heart for PTSD.  58% voted "no," and another 9% rode the fence, saying "perhaps" -- but only if PTSD were diagnosed in the war zone, which really affects far fewer people.

The IAVA's Ray Kimball wrote a good op-ed piece at Military.com in favor of expanding the award -- that's linked here.

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The more you talk with veterans who have PTSD, the more you realize how long the effects can be -- vets who are still struggling mightily with events that occurred 40, 50, sometimes even 60 years before (as well as a lot more recently than that.)  The sheer extent of the suffering, to me, puts this allegedly "invisible wound" on a par with ones that can be more clearly seen.  Though seriously, I bet if you ask a knowledgeable spouse or family member, the so-called "invisible" wound of PTSD is fairly easy to "see" in the the effect its had on the life of the veteran, and his or her family.  Studies like the one conducted on Vietnam veterans in Australia even shows residual effects on family members of veterans with PTSD into the second generation.  It may be "invisible," though I don't think it particularly "is," but it's certainly also "the gift that keeps on grieving," as one veteran so aptly put it.

It's weird and a tad unpleasant to see a divide developing (or perhaps the divide was always there, and is just now being articulated) between those with external and internal injuries -- especially since the ones injured externally seem to be the ones "pooh-poohing" the validity of the more internal injuries. Then, of course, there are those who've suffered both kinds.  Max Cleland comes to mind, the former Secretary of the VA, who decades after Vietnam learned he had PTSD, in addition to his obvious physical wounds as a triple amputee -- we blogged about him, here -- as do some other veterans who have unfortunately passed on.  Perhaps we need to hear more from those veterans who understand both types of injuries, and learn which side they argue in this debate. 

Typically, suffering begets compassion -- people can be fairly un-feeling about topics they've yet to have experienced personally, discounting motives and pain quotients alike -- so who better to understand which types of wounds really "count" than those who have cruelly suffered both? My guess is it's going to be from this corner that the rest of us learn how to more properly weight the stunning, substantial and frequently lifetime effects of this so-called "invisible wound" we refer to as PTSD.

Moving Violations, or the Needle in the Red Zone - Combat Veterans and Adrenaline Addiction

Adrenaline in combat helps the servicemember stay alive, and execute the plan.  Being addicted to the same adrenaline rushes after combat, though -- back on the home front -- can go from being an asset to a liability -- especially behind the wheel or on the motorcycle, and contributes to the sad phenomenon known as "non-combat deaths" from various origins.

Enough returning combat veterans kill themselves through reckless driving that different steps are being taken to warn participants of the semi-obvious dangers:

The Guardian (UK) newspaper has a story in today's paper, previously published yesterday in the Observer (UK), about the the British military's current advertising campaign to warn returned servicemembers about the dangers of amped-up, reckless driving.  The article, "Ads warn soldiers back from war zones against reckless driving," is linked here.

Says the article, "British soldiers are twice as likely as civilians to die as a result of reckless driving, because they have difficulty adjusting to normal life after returning home from active duty, according to official statistics."  The ads feature catchy slogans, such as "Drive Carefully.  You're Tough, but Not Invincible," and one directed to motorcyclists, "You're An Accident Waiting to Happen."  Hmmmn.  Those ads are likely to catch people's attention -- in fact, almost 60% of troops surveyed said they would think about slowing down, said the article, after considering them.

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Rick Roger's article in the May 23 issue of the San Diego Union-Tribune talked about the rash of non-combat fatalities among Marines at Camp Pendleton, many of whom had died in motorcycle fatalities.  Five Marines had died in the past eight days, where the "confirmed or probable causes" were homicide, suicide and traffic accidents. The article described Marine commanders and commands "backtracking to see if we need to do anything different to avoid these things happening again.”

It also clarified:

“Two of these deaths were caused by apparent motorcycle accidents, an area of deep concern for our Corps as motorcycle fatalities continue to rise at an alarming rate,” the statement said. “In a recently released All-Marine Message, the commandant outlines guidance and directives designed to curb motorcycle injuries and fatalities.”

Motorcycle-related deaths in the Marine Corps have risen every year since 2004, when there were seven. Last year, there were 19, according to the Naval Safety Center.

As for efforts to minimize combat stress and substance abuse, Camp Pendleton officials said the base has programs, policies and officers devoted to outreach and education. They also said each unit conducts monthly random drug tests on a mandated percentage of its Marines."

(Since that article was published, even more Marines have died as a result of motorcycle accidents.  See the article by Trista Talton in Friday's Marine Corps Times, linked here.  She writes, "Twenty Marines have died in motorcycle wrecks since Oct. 1, making this fiscal year the deadliest on record despite the Corps’ efforts to reduce two-wheel fatalities."  YIKES.

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From an article in the May 13, 2008 edition of the Marine Corps Times:

The new order, a work in progress for about six months, was initiated because of the number of motorcycle fatalities and injuries occurring within II MEF. From October 2007 to January 2008, more II MEF Marines died in motorcycle wrecks than in combat.

According to the order, released April 29, most of those deaths involved junior Marines and included things such as reckless behavior, blatant disregard of orders and policies, lack of proper training, little driving experience, alcohol and willfully disobeying state and federal traffic laws.

Information about the order is linked here.

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"Adrenaline addiction" is a familiar concept but by no means an official diagnosis (there are, however, informal support groups for it, on the Web, although I wonder if they're not just catchy names for invitations to drag racing and hang gliding events :-).

Sgt. Chad T. Jones wrote about it, back in April of 2004, in an article called "Flipping Off the Switch Can Save Your Life," linked here, first published in a Fort Bliss military publication, called the NCO Journal.  He introduced the article by saying:

A Soldier who has recently returned from Iraq might experience a need for a combat-level rush, called adrenalin addiction. The cravings for this excitement could kill him, but a patient, informed leader can intervene to save the Soldier’s life.

This information is a little on the generic side (in other words, seems like common sense) -- but apparently it's worth thinking about for those who haven't already considered it.  (It would be interesting, too, to learn the age ranges of those surveyed, above, who thought that just seeing the ad's message would reinforce their behavior towards slowing down and being more reasonable.  My guess is those were the older survey participants, because with age comes wisdom -- or so they say -- and/or the change to experience a few close calls with reckless behavior, which also has an impact on slowing us down.

From the same 2004 article:

Adrenaline addiction is something Soldiers returning from deployment are susceptible to, and is described as the need to engage in excitement-seeking behavior, said Col. Robert Gifford (Dr.), associate professor of psychiatry, Uniformed Services University of Health Sciences.

“Soldiers, when they come back from a deployment, have often been observed engaging in ‘excitement-seeking behavior.’ It includes a lot of people who liked excitement before and
Soldiers who come back [from a deployment] and miss the excitement, and sense of purpose that comes with a deployment,” Gifford said.

Usually, Soldiers are able to adjust their lifestyle or compensate for the lower operation tempo, but unfortunately other Soldiers “can’t find adequate ways to fulfill themselves, and they become excitement junkies,” said Lt. Col. (Dr.) David M. Benedek, associate professor of psychiatry, Uniformed Services University of Health Sciences.

Specific evidence stating why a Soldier seeks danger is not existent, Gifford said. But a popular opinion among medical professionals is that Soldiers are trying to replace the constant adrenaline needed to be successful in a combat environment.

“Operational or combat environments require a sense of alertness all of the time and it is very difficult to turn that off when you return home. Even though Soldiers are glad to be home, many found features they enjoyed while deployed,” Gifford said. “Sure it’s hot and miserable, but there is a sense of purpose. Suddenly, you’re home and those senses of purpose or excitement are suddenly gone, and people may not want to give that up so quickly.”

One way emotion leads to the reckless behavior is that Soldiers feel indestructible when they get home because they survived combat. That carelessness or sense of being indestructible can be dangerous, Gifford said. “Clearly any person who gets involved with risky behavior puts themselves in a position to get hurt, or killed,” he said.

While "adrenaline addiction" or being an adrenaline "junkie" isn't a true "addiction," as defined by the experts, there are some obvious similarities, including developing cravings for the environmental stimulants that provide the adrenaline rush -- many of which were available in combat situations, but not on the home front.  It's hard for many returning servicemembers to calm down -- and this is understandable -- after the rigors and the scares of combat.

Says the article:

"Upon detection [of the problem], leaders have many options they can use to help the Soldier. “There are a variety of mental health sources,” he said, but many Soldiers feel more comfortable talking to Chaplains or someone else. The important thing is to get the problem surfaced.”  Once the problem is brought to light, it’s important to figure out why the behavior is occurring. “Reckless behavior may be a signal of a number of illnesses or situational things that might resolve itself on its own or it might take a medical professional to figure out what to do,” [Col. Robert] Gifford said."

As I'm typing this out, though, I'm reading an email from a favorite Vietnam vet, telling me about the battle for Hill 881, and saying, in part, "without masses of adrenaline rushing through us, we couldn't have done this..." Aye, there's the rub.  Sometimes it's a total asset to have it; and just as easily, it becomes a grave liability.  Context is everything.

If you remember watching the Kellee Twiggs video (SSgt. Travis Twigg's wife, speaking after his death from PTSD), you will recall her talking about how jumpy her husband was -- how he couldn't sit still long enough to watch a movie with her and the kids; that his legs were always twitching.  To a certain degree, this must be a conditioned response from combat -- all that hyper-alertness turns into just plain jumpiness, with nowhere to go.  No wonder people try to bleed it off, doing risky things -- it keeps the feedback loop primed.

Sad to say, though, it's a feature of post-deployment life that servicemembers will need to get a handle on, through any reasonable means necessary -- and with good advice from practitioners they trust -- because failing to do so will prolong their suffering, and put their safety and sometimes that of other people's at risk.  Good for the British to be doing these ads, but as the popular saying goes, you can't really regulate human behavior. Suggesting that there might be a problem, though -- may be what amounts to a start.  An attempt to get the needle back out of the red zone...

Find the Cost of Freedom, Buried in the Ground

It's an old Crosby, Stills & Nash song, by Steven Stills. Many of us who were there in the 70s still remember the words. I know I can recite them from memory: "Find the cost of freedom, buried in the ground. Mother Earth will swallow you; lay your burdens down."

Tomorrow is the Fourth of July.  Not only my favorite holiday the whole year through -- sorry, I'm a New Englander, we're just born that way -- but also another opportunity - along with Memorial Day, and Veterans Day - to stop and honor the service of those who sacrificed their lives for freedom, or at least, responded to what they saw as the call of duty that they responded to, while others did not. Those whose blood was shed on American soil -- in Lexington, Massachusetts, in the Revolutionary War -- and also, more recently, in the jungles of Vietnam, in the mountains of Afghanistan and in the sands and urban jungles of Iraq.

I'm thinking today about censorship -- and the power of an image to convey, in a single instance, what those of us who labor over our words perhaps never can.  The picture, they claim, is worth 1,000 words -- perhaps because it communicates, in an instant, across barriers of language, space and time -- what human beings instinctively understand, nonverbally.  With war: that there is a price; that it is never really glorious; that those who give their lives often do so -- as the poet W.H. Auden wrote about the famous art masterpiece, the "Fall of Icarus," by the Dutch painter, Brueghel -- in a depressingly inglorious context:

"About suffering they were never wrong,

The Old Masters; how well they understood

Its human position; how it takes place

While someone else is eating or opening a window or just walking dully along...

If you don't remember the Greek myth of Icarus you might need some refreshing.  He's the pre-Wright Brothers son of Daedalus, whose father built him a pair of wings, in order to take flight and escape from the island of Crete.  But the father glued the wing feathers in with wax, and then warned his son not to fly too close to the sun (probably without explaining actually why.)  Icarus partially succeeded in his goal -- he was able to fly, but in flying, did get too close to the sun -- at which point the sun's rays melted the wing feathers' wax and he literally dropped out of the sky, into the ocean -- having succeeded in his fabulous quest and also painfully failed, all at the same time.  That's not the parallel with the armed forces: the parallel worth drawing here is that sometimes death on a glorious "mission" turns out to be a most pedestrian thing, and the rest of us, unless we're apprised of it, don't even notice or celebrate.  On a deeper level, it brings up the question: as Americans, how exactly do we "support the troops," if we're not even really aware of what they're up against?

Unlike Vietnam, where grainy black and white news footage of U.S. soldiers fighting and dying in foreign jungles was often watched during dinner, with Walter Cronkite narrating -- in Iraq and Afghanistan, we're reduced to very little coverage and certainly not much that could "upset" our "overly tender sensibilities."  No flag-draped coffins being offloaded at Dover Air Force Base, instantly communicating that for every loss in combat there's a grieving, distraught family and a hole in the community, left by that veteran, that will never be filled.  Even those, like me, who don't exactly excel at math -- we're more than dimly aware that for every servicemember KIA -- or killed in action -- there are scores more wounded and disfigured for life -- emotionally scarred (invisibly) as well as visibly.  The human costs are staggering: those are daddies and mommies, sons and daughters, brothers and sisters, employees and employers who come home different: maybe unable to work, maybe unable to function - initially or long-term; maybe unable to take care of their families while they struggle with their own wounds of war.  This is the human cost of war: it exists whether we are personally dialed in to it and aware of it, or not.  It is, to use the words of Hedley Peach, a "generic effect of combat."

And while the news media gives scant coverage to what is happening in the conflicts in Afghanistan and Iraq, as surely as the hands of our clock tick daily the minutes and the hours, somebody's sons, daughters, brothers, sisters, fathers, and mothers are dying, and being injured -- somewhere.  We can be for or against the wars -- forget that noise for now -- but at the very least, we ought to be for the veterans.  And their families.  If what happens is fully what they signed up for: so be it.  I'll say this for myself, if no one else: They're better people than I am.  If it's not what they bargained for: even more reason to feel compassion for what they're going through.  But here's a pretty elementary principle: if we don't see it, we can't grasp it -- and we move on with our lives as though nothing were really happening.  No coffins at Dover? No bodies on the news?  I guess this war isn't really costing that much in human terms after all...it's just another blip on our radar, hardly making a difference among the rest of the pronounced concerns of our lives and welfare.  Except that it IS happening -- and men and women are dying, and being injured, often grievously -- and we're, generally speaking, like the villagers in the Icarus poem, above (read the whole thing) pretty unaware of how that affects us, or if it even does.

And THAT is where journalism comes in, and photojournalism -- to convey in a single image, what dozens of column inches can barely touch.  A single image that resourcefully, potently conveys the reality of life and death on the knife edge, on the tip of the spear -- somewhere around the globe, and challenges you, me, us -- the viewer -- to say that it matters, and that we finally understand.

Maybe that's why in every craptastic Third World-ish revolution, they always kill -- um, that would be the military who does the killing -- the intelligentsia -- the artists, the poets, the thinkers, the intellectuals -- first.  Because I guess if you even goad the populace at large to think, why, you're a highly dangerous individual, and should be stopped -- before you can do any more harm (I mean, good.)

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Want a riveting image, that "stops the presses," and conveys for all time the intrinsic truth -- or at least, one powerful truth -- about an experience?  Turn to a photojournalist.  I've read more words than I can think of in my time, but if you want to know what I remember -- it's the images, often Pulitzer Prize-winning, from the eras of our shared experience.  Vietnam? It's the naked young girl, covered in Napalm, running from her burning village.  (We dropped the Napalm, btw...) Famine in Africa?  It's the buzzard, waiting for the tiny dark baby with its protruding ribs to just "hurry up and die, wouldja?!" so the buzzard could eat it.  (The photographer who shot that amazing scene, and won a Pulitzer Prize for it, later killed himself -- perhaps because those who witness tremendous suffering, also suffer tremendously themselves.)

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I'm not going to say who it is, because -- call me a fatalist -- I don't want to wake up tomorrow and find out that he's dead.  ESPECIALLY not on the Fourth of July -- that would be offensive in the extreme.  But the other day, some well-known and ridiculously good photojournalist blogrolled me -- stuck a link to this blog on his blog -- and I checked it out, to see what his stuff was like -- and of course it was riveting.  He's an embedded photojournalist in Iraq, or was, I should say, until the Marine brass apparently got fed up with him, and summarily pulled him out of his embedded assignment and out of the country.  His only offense, from the sounds of things?  Shooting the aftermath of a suicide blast in Ramadi -- you know, the Anbar province -- the Sunni triangle -- the previous hotbed of violence in Iraq -- which if we're to read the mainstream media, why, all that has calmed down considerably from a few years ago, and there's hardly anything brewing there at all.  Well, except for the lives of scores of people who died there, INCLUDING MARINES, in a suicide bombing just last week.  This guy documented it -- as sensitively as one could, given the horrific nature of the scene -- and he expressed the emotional toll it was taking on him, as no other experience had.  And somebody in the Marine Corps upper echelons took offense at what the rest of us call -- oh, I don't know -- the First Amendment -- and took steps to pull him out of there, on the double.

Let's HOPE the guy lives long enough to evacuate safely.  Really.  And then let's hope he still gets to show what he shot, at great personal cost -- because some of the rest of us (it's a refresher course: we're called Americans) want to actually SEE the cost of freedom -- in a way that those of us who don't serve, don't know; and those of us who do, and did -- know only too well.  It's only fair.  If we sanitize the living daylights out of these wars -- for what? -- not only will the American public not "get" the tremendous price paid by those serving AND their families; they won't be as compassionate to the same people afterwards as they need to be.  It's in all of our best interests to actively fight for, and preserve, the freedom of the press.  And that means photojournalists, who document war's horror, sufferings, and triumphs in a way no print journalist could ever begin to approximate.

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For my part, when I saw the photos in question the other day, I had myself a good, therapeutic, and instantaneous cry -- not just for the crumpled bodies of THOSE Marines on the ground -- he was subtle, nuanced and concerned enough not to show their faces, or anything else that identified them -- but for all the others I knew and knew about, who'd fought, been injured, or died there -- or returned home, not quite as intact, in body or soul, as when they'd left.  To deny us, as Americans, the chance through images like this to share the plight of those who are fighting on our behalf elsewhere in the world, is to deny us the chance to share what servicemembers are going through; and to deny them the chance to know that somewhere out there are people who "get," admire and respect the tremendous price they've paid through their service.

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The Marine Corps, which wants to sign more patriotic young sons and daughters up to fight, apparently thinks that by constraining the version of what reality is to just a portion of the whole will keep them happy and us in the dark, and people like this brave guy, the photographer, well, in complete limbo.  Little do they know that the patriots will still fight, but the rest of us could use an education course in compassion, sensitivity and yes, tenderness for those who've fought in battle, that only comes through expanding our horizons, and by facing the whole truth of what they're really going through, as combatants. Don't sugar coat the truth: everyone who goes to war comes back changed -- that's just how it is.  Let's develop a compassion and an understanding for what they go through, not sweep it under the rug.  The death and injury of those with whom they serve is often the most scarring aspect of combat there is.  Just ask those who've never been the same since.

So especially on this Fourth of July, as one extraordinarily talented photojournalist sits in limbo, let's hope still alive, ripped out of the fight for no other reason than that he was getting a little too close to home in showing us what war is really like -- I'm appalled to think that as Americans, we're not being trusted with the whole truth, when it's expressly the whole truth that we need, as Martin Luther King once said, to set us free.  We need to know the human costs of these battles we're in.  And suppressing the images of that just harms our servicemembers and their families, and cripples the compassion of us as a people.

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Until I looked it up just now, I didn't realize that Crosby, Stills and Nash song had other lyrics.  Apparently it does.  Besides the chorus (above), which I remember so well, there's another verse as well:

Daylight again, following me to bed
I think about a hundred years ago, how my fathers bled
I think I see a valley, covered with bones in blue
All the brave soldiers that cannot get older been askin' after you
Hear the past a callin', from Armegeddon's side
When everyone's talkin' and no one is listenin', how can we
decide?

On the behalf of all those "brave soldiers that cannot get older," could we at least not suppress and crush the efforts of those who are trying to get us to see the whole truth?  What truth is that, you may ask?  The very cost of freedom, buried in the ground -- in Iraq, in Afghanistan, and in Vietnam beforehand. Godspeed, Z.  You are a witness on ALL of our behalf, to the price that war really exacts, on those who serve in it.

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

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

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

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

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

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

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

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

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

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

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