Healing Combat Trauma

Quotable Quotes -- Edwin Shneidman on Walking Someone Out of Hell

Edwin Shneidman, who we've written about frequently on this site, was a mentor to Mark Goulston, M.D., the author of "Post-Traumatic Stress Disorder for Dummies," linked here. Goulston credits Shneidman with teaching him how to really listen to others, particularly patients, in a story he relays, here:

"Mark, if you listen for hurt, fear and pain, it is always there. And when the other person feels you listening and feeling them, they will lower their guard, open their minds and hearts to you, allow you to enter and comfort them and if you’re fortunate, will let you walk them out of hell." -- Edwin Shneidman to Mark Goulston, M.D.

Once again, we see the benefit of listening with the heart and from the heart, echoing yet again the great quote of Paul Tillich, that "the first duty of love is to listen."

Quotable Quotes -- Edwin Shneidman on Two Questions to Help Avert Suicide

From the father of "suicidology," Edwin Shneidman, whose interest in the field began during his work at the VA, where he set out on a quest to review the suicide notes left in veterans' files, and see if he could begin to understand the pathology and the trajectory of what drove them to end their lives -- a form of psychological autopsy. His deeply caring and understanding quote:

"The most important question to a potentially suicidal person is not an inquiry about family history or laboratory tests of blood or spinal fluid, but "Where do you hurt?" and "How can I help you?""

-- The Suicidal Mind, by Edwin S. Shneidman. London: Oxford University Press (1996).

Editor's note: For previous articles about Shneidman and suicide, click here and here, among others.

 

Quotable Quotes -- Sarah Haley, M.S.W., on Combat's Effect on the Veteran

"Combat veterans may play down or embellish their 'war stories,' but initially their reports should be taken at face value. The only report that should not be accepted at face value, although one may choose not to challenge it initially, is the patient's report that combat in Vietnam had no effect on him." -- Sarah Haley, M.S.W., "When the Patient Reports Atrocities: Specific Treatment Considerations of the Vietnam Veteran," published in Archives of General Psychiatry, Vol. 30, Feb. 1974.

It Takes a Village: Ritual, Power, Healing and Community

Ritual is another way that human collectives (tribes, societies, etc.) attempt to purge grief communally after trauma. While military tradition may be strong on tradition and ceremony, it's noticeably light on ritual. Ritual is more primitive, primeval, visceral. But it's also got a long, long background, anthropologically speaking, in helping human beings all over the world cope with the benchmarks of life on earth: birth, death, and everything significant in between. 

Recently we took a look at storytelling among Native American warriors as a way to address trauma after war communally. Here we hear African tribal elder Malidoma Somé, Ph.D., bridge the gap between first world and third world as he describes a ceremonial "cleansing" ritual in which various men participated. We'll go into more detail on this topic later, and hear about and from those experienced with the popular men's movement in the 80s and 90s, who followed examples such as the one Somé describes -- but in the meantime, let's use this excerpt from one of Somé's books to orient ourselves to some of the benefits of ritual after grief, such as that which warriors -- servicemembers and veterans -- experience:

"The cleansing was happening. So much grief surfaced that ... it was a success. I saw hot tears flowing from wet eyes. That felt good. I heard sincere groans and yells and screams that almost made me feel like I was home again (in an African village). The ritual was working.

Even though it was just scratching the surface, the scratch was at least opening something. In a way, there was an invitation to unleash grief. The experience left people empty, light, and -- above all -- miraculously prone to celebrate. I understood why, in the village, life rotates around grief and celebration. People celebrate because they have paid their dues to the dead. The other side of real grief is real joy. Unfinished grief translates into petty joy and silly amusement. The experience taught me a great deal. Without ritual, humans live in nostalgia.

When there is an opportunity for people to mourn their losses, the horizon for rites that heal will be pure and bright, and healing will come pouring into the souls in a great moment of reunion."

-- Malidoma Patrice Somé, from "Ritual: Power, Healing and Community: The African Teachings of the Dagara." 

Transpersonal Psychology, PTSD and Spirituality: A Therapeutic Approach

From a brochure about a now-past seminar given by Dr. Marius Koga, a look at the transpersonal therapeutic approach to PTSD and spirituality. I shared his comments with a friend, an Iraq veteran with PTSD, and she affirmed how completely his remarks fit with her impression of her situation. In her words: "He explained the exact reasons why I thought God hated me and was punishing me and why I turned to drugs. I always thought I was the only one who thought that way, and so it was nice to hear that from him."

In Dr. Koga's words:

"It is common for PTSD clients to seek religion and spirituality as part of their healing process. However, most psychotherapies are focused on the ego and personality constructs, while religious or spiritual considerations have been traditionally ignored. It is only in recent years that a therapeutic modality known as “transpersonal psychology “ has emerged which reintegrates psychology and the personality with the soul. The client is encouraged to actively maintain his/her individual self-concept in order to participate actively in his/her recovery. Concurrently, the client is guided to incorporate his/her individuality into the larger plane of the collective identity (including family, community, and religious and spiritual helping resources) to undergo personal transformation and growth. Our military especially, coming home from Afghanistan and Iraq, are seeking answers to painful questions about the gruesome realities of warfare, the value of personal faith, and the worth of human life itself. Many find that their faith in a God that is always available to respond to one’s personal tragedy can be utterly shattered. Soldiers and others who are unable to resolve such challenges find themselves lost in a spiritual flatland, which can take many nightmarish forms. They may feel abandoned by God, they reject or curse God, and they feel that God was powerless to help or even non-existent. They may even rationalize that their body mutilation, PTSD, or Traumatic Brain Injury was deserved punishment from God, or, in extreme, believe that their eternal damnation is God’s ultimate punishment. All too often, they feel they have no recourse but to numb their pain with drugs and alcohol. Their families suffer with them. By providing the opportunity for introspection about the meaning of trauma for the client’s life, transpersonal psychology helps soldiers, their families and friends, and others who have experienced PTSD and other traumatic events, to renegotiate the passive and silent state of the sick role and regain a sense of journeying, integrating, and healing." Marius Koga, MD, MPH, is a Diplomate of the American Academy of Experts in Traumatic Stress and an Associate Clinical Professor of Public Health at UC Davis School of Medicine. He is also a Professor at the Institute of Transpersonal Psychology in Palo Alto where he is directing a pilot center for trauma studies. Dr. Koga has developed courses in mental health and spirituality for Chapman University and has been the Course Director for Transcultural Mental Health and Spirituality at Tulane Medical School. A former political prisoner, torture survivor, and refugee from communist Romania, Dr. Koga’s interest is on PTSD in refugee populations and US military who are Afghan and Iraq war veterans. He has given numerous presentations, and workshops on spiritual dimensions of trauma in US and Europe.

Patrick Marius Koga, M.D., M.P.H.

Dr. Patrick Marius Koga is an Associate Clinical Professor of International Health at UCD School of Medicine, Dept. of Public Health and the President of the Veteran, Immigrant, & Trauma Institute of Sacramento (VIRTIS ). Dr. Koga was trained in Romania and at Tulane and his work in the past 20 years has focused on cultural and spiritual modulators of posttraumatic stress disorder due to armed conflict, complex emergencies, forced displacement, and immigration. His current international research work includes a cross-cultural psychometric evaluation of the reliability and validity of the Civilian Version of the Mississippi Scale for Combat-Related PTSD in the present Kyrgyz-Uzbek conflict in Kyrgyzstan, and a resilience study of the Iranian refugees in Turkey. At UC Davis Center for Healthcare Policy and Research, Dr. Koga is focused on needs assessments and epidemiological surveys of the psychosocial reintegration of OIF/OEF veterans with PTSD and of the disparity gap in mental health services available to Eastern European, Afghan, and Iranian refugees in the Greater Sacramento Metropolitan Area.

More about Dr. Koga, from his bio at the Institute of Transpersonal Psychology in Palo Alto, CA:

Patrick Marius Koga, MD, MPH

• MD, University of Timisoara, Faculty of Medicine, Romania, 1984. Specialization: Adult Psychiatry, 1988 
• MPH, International Health & Development, specialization in Cross-Cultural Mental Health & Medical Anthropology, Tulane School of Public Health & Tropical Medicine in New Orleans, Louisiana, 1999
• Board certified and Diplomate of American Academy of Experts in Traumatic Stress, 2006.

Marius is a Professor at the Institute of Transpersonal Psychology. A psychiatrist and a former political prisoner, torture survivor, and refugee from communist Romania, Marius’ professional interest focuses on the cultural, religious, and spiritual dimensions of PTSD in war refugees from Eastern Europe and the Middle East who have resettled in California. His spiritual path unfolds out of over two decades of practice of Advaita Vedanta, Zen Buddhism, martial arts (5th degree black belt in Karate-Do, 4th degree black belt in Judo and Jujutsu) and out of several years of monastic living as an initiated disciple of the Ramakrishna Order of India.

For the past ten years Marius has also been promoting cultural, religious, and spiritual competencies in medical student education in various capacities such as Dean of International Medicine & Development, Cambridge Overseas Medical Training Programme, Cambridge, UK, Course Director for Transcultural Mental Health and Spirituality at Tulane School of Medicine in New Orleans, and currently as an Associate Clinical Professor of International Health at the UC Davis School of Medicine. 

Marius believes that in an increasingly globalized world, ridden with disparities, conflicts, and violence, ITP has a unique opportunity to partner its expertise and leadership in transpersonal psychology with public health, medicine, government, policy makers, donors, educators, and factors of social change to reduce suffering and mental illness, and to promote individual and collective growth and well-being. 

Editor's note: For more on Dr. Koga's work with VIRTIS, which also focuses on veterans, click here.

Resources on Military Sexual Trauma: VetWow's Short Podcasts for Survivors, Friends and Family

Military Sexual Trauma, like PTSD another "invisible wound," is unfortunately more prevalent in the military than we would want to believe, though little discussed officially. It's different though when combatants get together who have experienced it. Among female servicemembers in particular, it is all too often a common experience; and whether among male or female servicemembers, the after-effects can be devastating. 

At its root, it is a betrayal of trust -- the military is designed to be a "family unit," so assault within this context can feel to survivors like incest -- and many survivors describe the hazing by their command as more difficult in its own way than the actual assault (ugh). Civilians in particular have a hard time wrapping their brains around how prevalent the problem is, how light or nonexistent the penalties (despite official "policies" to the contrary), and how devastating the aftermath is for those who suffer -- who then have to navigate an often-byzantine system of claims and benefits for their care. (Fortunately, MST survivors are able to access VA in a very direct manner...it's worth watching Susan's discussion, linked here, to understand how.) Family and friends -- who may find themselves supporting the survivor -- also need education about how best to offer support, in ways that are constructive and not counter-productive or further traumatizing.

We've written about military sexual assault on the site before, here. "Military sexual trauma (MST) is the term that the Department of Veterans Affairs uses to refer to sexual assault or repeated, unsolicited, threatening acts of sexual harassment –- that occurred while the veteran was in the military."

Susan Avila-Smith, a former Army linguist who suffered her own sexual assault in the military, is now a formidable MST/PTSD advocate and the founder of VetWow, where she advocates for others who have experienced MST and PTSD, and focuses on resolving their claims. A settled claim can provide the MST survivor with financial independence, which is important also in healing. Avila-Smith does not charge for her services, though she does encourage the male and female survivors to pay this service forward in their own lives, once they have stabilized enough to do so, by contributing to others in various ways. 

Recently I got a chance to work with Avila-Smith on creating a "channel" on YouTube for short, one to three minute podcasts about various aspects of MST for survivors, their families and friends, their advocates and the media. The videos/podcasts are organized into the following categories. Please watch them, and share them with your friends and colleagues. Particularly let those in the military (active duty) and veterans know about this resource. As Avila-Smith herself says, it's important to get the word out about military sexual trauma, because "you can't tell by looking at someone" if they've ever been sexually assaulted. For those who have been, these resources can be tremendously reassuring, constructive and helpful.

For MST survivors:

• Symptoms of MST in Veterans;
  
• What PTSD Feels Like to the MST Survivor;
  
• Difference between "Traumatic Stress Syndrome" and "Post-Traumatic Stress" Syndrome; 
  
• For the MST Survivor: Thoughts of Death and Self-Harm;
  
• Interested in Becoming an MST Advocate?;
  
• For Female MST Survivors, Hoarding Can Be Typical;
  
• For MST Survivors: "Hitting the Wall";
  
• For the MST Survivor: Working with Your Therapist Effectively;
  
• For the MST Survivor: Working with the Veterans Service Officer ("VSO") Effectively;
  
• For the MST Survivor: Achieving Satisfaction with Your Advocate;
  
• MST Survivor May Fit VA's Expanded Definition of "Homeless";
  
• For the MST Survivor: Learn to “Pay it Forward";
  

For male survivors of MST:

• For Male Survivors of MST;
  

Self-care and healing resources:

• For the MST Survivor: Good Self-Care Habits;
  
• Alternative Therapies for PTSD.;
  

For friends and family:

• Welcome Friends and Family!; 
  
• What PTSD Feels Like to the MST Survivor;
  
• For Friends and Family: When an MST Survivor Wants to Share Their Story with You;
  
• For Friends and Family: How to Help and How Not to Help an MST Survivor;
  
• When the MST Soldier Comes Home: Best Practices for a Good Outcome;
  

For active duty:

• Why Active Duty Advocacy is So Important;
  
• Active Duty / Filing a Restricted Report;
  
• Active Duty / Filing an Unrestricted Report;
  
• Filing an Unrestricted Report: What GENERALLY happens;
  
• Filing an Unrestricted Report: What SHOULD happen;
  
• Unrestricted Reports: the Danger of "The McDowell Checklist";
  
• For Active Duty: More on the Administrative Discharge;
  

Dealing with the VA:

• Accessing VA Services as an MST Survivor;
  
• Guide to Navigating the VA;
  
• When You Get a Letter from the VA;

Filing and winning a claim:

• Why Filing the Claim Quickly is in the Veteran's Best Interest;
  
• How to File a Claim for Military Sexual Trauma: The Key Items Needed in Your VA Claim File;
• Winning an MST Claim, Part I;
• Winning an MST Claim, Part II: How Long It Takes, Strategies for Self-Care While You Wait, etc.;

For advocates:

• Interested in Becoming an MST Advocate?;
  

For prospective donors:

• For Prospective Donors;
  

For the media:

• For the Media: When You Want to Interview an MST Survivor;
  
• For Media Who Want to Interview MST Survivors and Veterans;
  

General interest:                                                   

• Why MST is a Problem and Why the Solutions Don't Work;
  
• Explaining a Few of the Myths Surrounding Military Sexual Trauma;
  
• Which is Worse for the MST Survivor: The Rape or the Command?;
  
• Why the Current System Needs an Overhaul;
  
• Strange Facts about MST and the VA: Offenders and Victims;
  
• What I Envision in a Perfect Future: Blue Sky Thinking on MST;
  

Editor's note: For more resources about military sexual trauma, particularly filing and winning a VA claim, head for Susan Avila-Smith's website, VetWow; to support (i.e., donate to) those who advocate for victims of military sexual trauma, go to PackParachute; or to follow the legislative progress on this issue, go to Service Women's Action Network for information on the legislative angle. Remember, this is a problem that affects both men and women in the military. And most of all, watch the videos linked above -- and share those with family, friends and veterans' advocates. Thank you.

Kind Words from a Mentor and Friend about "Healing Combat Trauma"

Unsolicited feedback can be encouraging, especially when it's positive. Had a very nice surprise of that kind this past this past week when I received a lovely and unexpected email from Arthur Egendorf, Ph.D., a dear mentor and friend, whose own work with war veterans recovering from trauma gave me practical hope that good, heartfelt work could be done in this area.

(Egendorf is a Vietnam veteran [Army intelligence] with a Ph.D. in psychology from Harvard, and a lifelong interest in therapeutic healing modalities, beginning with talk therapy and branching out from there. He was one of the originators, in the 1970s, of the "rap groups," that allowed returning Vietnam veterans to have someplace to go and peers to talk with, when they weren't willing to take part in the services offered by the V.A. In any history of the Vietnam era that focuses on PTSD and veterans, such as Gerard Nicosia's encyclopedic "Home to War: A History of the Vietnam Veterans' Movement," Egendorf is one of a handful of experts from the time whose name keeps coming up.) 

I'll write more later in the month, as a certain anniversary date rolls around, about how much his award-winning book "Healing from the War: Trauma and Transformation after Vietnam," (sadly, now out of print) was put to constructive use with one veteran, whose life it helped to change. It's fair to say that my copy of his book is fairly well completely yellow from highlighting key passages, thoughts and inspirations, so it was especially gratifying to receive these unsolicited kind words from him.

Dear Lily,

In dedicating so much of yourself to the men and women who risk and give their lives for duty, honor, country you do all of us, this mostly sleep-walking America, a great service.  As tireless, fearless, noisy (when necessary) and deeply caring witness you give our soldiers and veterans what they deserve from this entire country but get from only very few.  As one who knows a bit of what it takes to love and care for bloodied and pained survivors who've fought for all of us and then have been mostly ignored, I salute and cheer you on to keep waking us up.  Keep shaking us, Lily.  Keeping making us see how much those who've served have given to us, and how much we owe our thanks, respect and unending care.  You go girl.  

Artie Egendorf 

Editor's note: For more of an introduction to Egendorf's work, here are a few posts that mention him, linked here, here, here (this one in particular, called "A Hand Across the Abyss: How Openness Helps Heal"), and here, among others.

More Praise for "Healing Combat Trauma"

Belleruth Naparstek, Ph.D. is a psychotherapist, author, and guided imagery pioneer who is also the author of Invisible Heroes : Survivors of Trauma and How They Heal, and Health Journeys: A Guided Meditation for Healing Trauma (PTSD), two items that have helped many veterans interested in healing to make definite forward progress.

This past year, Naparstek published an important and educational article in the Huffington Post in May called "Note to Colleagues: Please Stop Saying Post Traumatic Stress is Incurable," linked here, as well as one in February called "Returning Troops from Iraq and Afghanistan are Different From Our Vietnam Vets," linked here, both of which are "required reading" for those who want to understand what obstacles face veterans and clinicians alike in treating combat-based post-traumatic stress.

Just the other day I happened to read an article on Naparstek's own HealthJourneys site where she mentioned our very own Healing Combat Trauma as "an excellent site" and referred readers to it. Very gratifying praise indeed from a someone who's a true pioneer in thinking about and working with trauma survivors.

Praise for "Healing Combat Trauma"

Had a nice surprise at the week-long clinical training in PTSD at the National Center for PTSD. Picked up a copy of Ray Scurfield, Ph.D.'s comprehensive "War Trauma Resources," and in it read something very nice he said about this site: "Lily Casura’s very rich compendium -– she has over 100 categories of information! -- of books, article, commentaries, resources, other readings and information regarding military, veterans and their families. I am most impressed with Lily’s passion, dedication and abilities as an advocate for vets and their families." -- Ray Scurfield, Ph.D.

 Scurfield is and was one of my first heroes in this because of his longtime work with veterans healing from war trauma, so it's extra-nice to hear something like this from him. In addition to the resources he provides nationally, Scurfield is also the author of three key books about veterans and PTSD: A Vietnam Trilogy, Healing Journeys, and War Trauma.

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

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

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

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

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

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

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

Here are her remarks in full:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cast Adrift by Trauma in the Center of Your Own Universe...

I've been reading Belleruth Naparstek's book, "Invisible Heroes: Survivors of Trauma and How They Heal," and she makes an excellent point both about the safety and normalcy we unconsciously come to expect from life, and then the terrible way in which we find ourselves suddenly cut adrift from those same moorings through tragedy and trauma.

After first describing how the human toddler first takes sheer delight in realizing they are the center of their world and can "make things happen" -- by knocking over piles of blocks in play, again and again, or shouting and laughing at the sound of his or her own voice -- she the contrasts this with the sheer helplessness people feel because of a trauma-causing incident. Sagely, she describes the point:

"And because it is built into our human hard-wiring to love ourselves for being able to make things happen, the converse is also true: we lose self-regard when bad things happen that are beyond our control.  The essential insult of trauma is the helplessness it generates, and the inadequacy and powerlessness we feel in its grip.

Rational or not, we can't help but feel it's a reflection on our worthiness that, when confronted with a terrifying and terrible event, we didn't prevent it, escape it, or fix it.  So we somehow lose value to ourselves and, at a level we may not even be aware of, we feel guilty and ashamed."

This is a powerful and accurate description of what so many people go through after trauma. Good for Naparstek for bringing it to light.

Triggered by Talking about Trauma

It seems a bit paradoxical that the very act of attempting to talk about trauma might actually trigger trauma, and turn out to be "too much" for the traumatized person to handle, but this can be the case, according to Belleruth Naparstek, in her well-regarded book, "Invisible Heroes: Survivors of Trauma and How They Heal." She writes:

"This is because with PTSD, language can be a trap. If a deeply traumatized person is prompted only to speak and think about the events that created his distress, without enlisting help from the imaginative, emotional, sensory and somatic capabilities of his right brain, his symptoms can actually get worse instead of better.  Encouragement to "talk about it" -- a therapist's and, for that matter, a good friend's stock-in-trade -- can catalyze a tailspin of flashbacks, nightmares and overwhelming anxiety."

Clearly, we're just scratching the surface here of a much larger topic.  But while the case can be made that listening to another deeply is often quite therapeutic, having to talk about (relive) something traumatizing might have adverse effects.

Who -- and What -- a Survivor Is

Quotable quotes:

"I define a survivor as one who has touched, witnessed, encountered or been immersed in death in a literal or symbolic way and has himself remained alive." -- Robert Jay Lifton.

LIfton, an American psychiatrist and pioneer in PTSD studies from the 1970s, is also the author of "Home from the War: Learning from Vietnam Veterans."

(Hat tip to Chris Lombardi, for pointing this one out.)

"Ding, Ding" -- Pavlov's Comment on PTSD

Famous Russian scientist (physician and psychiatrist) and Nobel Prize winner Ivan Pavlov -- famous for his experiments with ringing bells, feeding time and dogs that evoked the characteristic "Pavlovian response" -- also had some things to say about PTSD.  Bessel van der Kolk, M.D., a Harvard-trained psychiatrist, writing in his scientific paper, "The Body Keeps the Score: Memory and the Evolving Psychobiology of Post Traumatic Stress," mentions that Pavlov thought that "individual differences in temperament account for the diversity of long-term adaptations to trauma."  Interesting!

Editor's Note: The item van der Kolk appears to be citing is Pavlov IP.  Edited and translated by GV Anrep.  "Conditioned reflexes: An investigation of the physiological activity of the cerebral cortex."  New York: Dover Publications (1926).

Upcoming Seminar: The Warrior's Journey: Healing PTSD (with Edward Tick)

The Warrior's Journey: Healing PTSD (6 CE hours)
Tuesday, April 28, 9 a.m. to 4 p.m.
Tuition: $150 general public; $130 Antioch alumni, faculty, staff

War's violence is so severe that it can cause the true self to become distorted or lost for life. Untold numbers of veterans from old and new wars suffer Post-traumatic Stress Disorder (PTSD). Newest estimates are that 20-40% of Iraq returnees come home with PTSD and its multitude of disabling symptoms. Countless more return with severe, disabling wounds to body and mind. Contemporary society and the institutions meant to serve veterans are in crisis and at a loss as to how to respond to this massive wounding.

In this workshop, gain insight into the psycho-spiritual approach to healing from war. Learn how PTSD is not just a stress and anxiety disorder. It is also an identity disorder, soul wound, interrupted initiation and social wound. Examine various forms of psycho-spiritual interventions and community activism that rebuild veterans' identities, shrink trauma and restore wounded dimensions of soul. Develop a deeper understanding of PTSD treatment philosophies and strategies that can bring hope and healing to veterans and their families. Explore the spirituality inherent in war and learn how to use it to heal veterans and society.

Instructor: Edward Tick, Ph.D., is a holistic psychotherapist, writer, educator, journey guide, activist and veterans' advocate. He has been working with veterans and survivors of war, violence and trauma since the late 1970s. He specializes in using psycho-spiritual, cross-cultural and international reconciliation practices to help veterans, communities and nations heal. He is founder and executive and clinical director of Sanctuary: A Center for Mentoring the Soul, and of Soldier's Heart: Veterans' Safe Return Programs. Tick is adjunct professor in both Communication and Global Studies at the Sage Colleges. Tick is the author of War and the Soul: Healing Our Nation's Veterans from Post-traumatic Stress Disorder.

Editor's note: for further information about the program, click here and scroll down until you see this particular seminar.

News from Hell before Breakfast: Journalists, War Trauma and PTSD

"I hate newspapermen. They come into camp and pick up their camp rumors and print them as facts. I regard them as spies, which, in truth, they are. If I killed them all there would be news from Hell before breakfast." -- attributed, perhaps erroneously, to Civil War General William Tecumseh Sherman.

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A different quote:

"On Thursday, June 26th, I witnessed the immediate aftermath of an Al-Qaeda suicide bomb attack.  Several dozen people lost their lives... children, old men, civilians, police, and military men.  The scene was horrific beyond words, even for someone like me who has a fairly high threshold for such things.

I found it nearly impossible to look through the viewfinder.  What I saw was abhorrently graphic, yet far too important for the world to ignore.  I present images that provide an uncensored view of a terrible event, and some small measure of dignity to those who lost their lives."

-- Zoriah, international humanitarian photographer, whose gripping images from that event were later censored by the U.S. military, and he was evicted from his embed assignment with the Marines. (The link to the post where he talks about those images, and shows them, is here.)

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PTSD from being a combat journalist of photographer, embedded or otherwise:  Not everyone who's exposed to combat trauma develops PTSD, as we know.  Recently, Kimberly Dozier, CBS correspondent and author of Breathing the Fire, says she didn't develop it from her horrific near-death incident in Iraq in May of 2006, though ironically -- according to Dozier -- almost everyone she interacts with believes thatshe must have.  (See article to that effect by Dozier, linked here.)  However...many do; and for others, the signs and symptoms take time to manifest themselves. 

---

Journalists bear witness, both to some of the most savage atrocities of wartime, though without the training and the mindset of combatants, and also to the suffering of the survivors, military and civilian.  Says one photographer who served in Vietnam:

It has been very difficult for me [to recount some of his memories from the past] as it has brought back many of the horrible nightmares that I had thought that I had finally put away. It did get them out in the open and off my chest so to speak and now my family now knows why I sometimes have to take those walks out into the woods alone to just get away. Hard to explain. I do have severe survival guilt as I have lost far to many friends in combat in up close and personal confrontations. I have many photos of me smiling and yes there were many good times. However; there were enough bad times to more than compensate for the good ones. I have learned to cope with this new world that I came home to only because I still feel a great need to help my fellow veterans. We 'Nam veterans are all but forgotten in my eyes.

Two significant resources: Dr. Anthony Feinstein's work, and the Dart Center for Journalism and Trauma.

Two excellent books:

Dangerous Lives: War, and the Men and Women Who Report It, by Anthony Feinstein (2002); and Journalists under Fire: The Psychological Hazards of Covering War, by Anthony Feinstein. (2006).  (Recommended by Jonathan Shay, M.D., Ph.D., noted PTSD expert.)  Shay wrote: "the first and only book about the occupational [psychological] hazards of being a war correspondent.  Published in Canada, will come out in the US next year from Johns Hopkins UP with a new chapter on embeds."

Dr. Anthony Feinstein is a professor of psychiatry at the University of Toronto and a neuropsychiatrist at Sunnybrook and Women's College Health Sciences Centre in Toronto. He is an expert on Post-Traumatic Stress Disorder in war journalists. Feinstein received a 2001 Guggenheim Fellowship to pursue his research. Dr. Anthony Feinstein's bio is linked here.  Much better bio, linked here.

For reporters: War, Journalism and Stress: The Self-Assessment Test, linked here. (General description of the test, linked here.)

What Feinstein has to say:

More than anything, says Feinstein, he’s learned that, “War is not good for journalists. They suffer from it.”

Specifically, they suffer post-traumatic stress disorder, substance abuse and anxiety disorders. One in five journalists, over the course of a long (15-plus-year) career, endures significant PTSD, says Feinstein. That means, among other things, bad dreams, flashbacks, numbness, an overly sensitive startle response and an inability to get close to others emotionally. One in four experiences depression. “And a number drink very heavily as well,” says Feinstein, “but I don’t know how many, because I never know for sure what they’re telling me.”

The most surprising revelation of the research for Feinstein? “I didn’t realize that the journalists were in such great danger. You see them when they report the news: cool, collected, with everything seemingly going on behind them. But these people are really right in the middle of it all.”

He is particularly sympathetic to still photographers. More than anyone, he says, these professionals have no choice but to get into the thick of things to do their jobs well.

The Dart Center for Journalism and Trauma, located on the campus of the University of Washington in Seattle, is a particularly good, targeted resource for journalists about reporting and trauma: both externally reporting, and internally experiencing trauma from reporting in war zones.  Click here to look through their extensive offerings, which are really superb.

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Who's the handsome young man in the photo? 

That's Robert W. "Grif" Griffin.  Griffin says, "I was a combat photographer with the 1st Cavalry Division Airmobile from 1966 to 1968 and 1970. I was in country [in Vietnam] as a photographer from 1966 to 1968, and back again in 1970."  (He was shot down near Quan Loi in 1970.)  He adds that he "spent 20 years in the Army mostly as a photojournalist/motion picture and still photographer."

According to Griffin, "the photographer who took the photo is Jere L. Smith, a fellow combat photographer and a Specialist E5 at the time. We were both assigned to the 13th Signal Battalion, which was part of the 1st Cavalry Division Airmobile."  At the time the photo was taken, Griffin was duplicating some slides for his Command for a Division briefing that was to take place in several locations at the same time: hence, the dupes.

Belleruth Naparstek, LISW - Psychotherapist

Psychotherapist, author and guided imagery innovator Belleruth Naparstek, LISW, BCD, has practiced psychotherapy for over 30 years. She is best known as the creator of the popular, 52-title Time Warner Health Journeys guided imagery audio series. Naparstek's first book, Staying Well with Guided Imagery, (Warner Books) continues to be a widely used primer for medical professionals and health consumers. Her second book, Your Sixth Sense, (Harper San Francisco) has been translated into 8 languages and has been called one of the more thoughtful and sophisticated looks at intuition. She is also the author of Invisible Heroes : Survivors of Trauma and How They Heal, and Health Journeys: A Guided Meditation for Healing Trauma (PTSD).

Naparstek has helped to make guided imagery part of mainstream healthcare by persuading traditional healthcare organizations such as Aetna U.S. Healthcare, the U.S. Veteran’s Administration, GlaxoSmithKline,The American Red Cross, Blue Shield of California, Ortho Biotech, Roche, Medical Mutual of Ohio, Amgen, Kaiser Permanente, and nearly 2000 hospitals, clinics, spas and hospices to distribute her guided imagery recordings, in many instances free of charge.

A warm, dynamic and compelling speaker, Naparstek has lectured across the country and around the world, training thousands of health professionals, corporate leaders, counselors, performing artists and health consumers in the use of her powerful, ground-breaking guided imagery techniques.

Her imagery has been involved in 24 clinical trials, with over a half dozen studies completed to date. Efficacy has been established for several psychological and medical conditions.

Naparstek received both undergraduate and graduate degrees from the University of Chicago. For years she taught graduate students at Case Western Reserve University's Mandel School of Applied Social Sciences. She lives in Cleveland with her family.

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.

Anand Kartha, M.D.

Anand Kartha MD, MSc, Hospitalist and Director of Medical Consultation Service at the VA was awarded this year’s David Littman Award. The award is given to a physician at the VA who demonstrates outstanding dedication to the VA's patients and its mission.

Dr. Kartha was a recipient of a Primary Care (GIM/FM) Academic Fellowship at the Boston University Medical Campus.  His years in the Fellowship were 2003-2005, and he spent them at the Veterans Admininstration Hospital, Boston VA Healthcare System.  The focus of his Fellowship studies were: Predictors of re-hospitalization/Utilization of health care resources in post-traumatic stress disorder.

Anand Kartha, MD, MSc, VA Boston Healthcare System, 1400 VFW Parkway, Mail Stop 111, West Roxbury, MA 02132.

Peter A. Levine, Ph.D.

BORN
February 19,1942

DEGREES
B.S. University of Michigan, 1964: Physics Engineering; and Minors in Mathematics and Psychology.

Ph.D. University of California, Berkeley, 1976: Department of Medical and Biological Physics: Group in Biophysics (interdisciplinary Program in Physical Biology; Life Science, Neurophysiology and Psychology.)

Ph.D. International College, Los Angeles, 1977; Independent Directed Tutorial, Psychology.

POSITIONS
1999-Member of Task Force, Institute of World Affairs, Psychologists for Social Responsibility and Presidential Initiative on Ethnopolitical Warfare, Twin Lakes, Connecticut. Setting curriculum and training for large scale disaster and Ethnopolitical Conflict development at post graduate level.

1998-Present - Founder and Training Director, Foundation for Human Enrichment, Lyons, Colorado.

1998-1999 - Lecture and training, C. J. Jung Society, Denver, Colorado.

1995- Consultant: Colorado Center for Bio-behavioral Health.

1994-Present - Consultant, Pain and Rehabilitation Clinic, Mapleton Center, Boulder Community Hospital, Boulder, Colorado.

1990-1995 - Director and Training Director, Ergos Institute for Somatic Education.

1988-1990 - President, Foundation for Human Enrichment-A non-profit resource in the health sciences.

1988-1989 - Guest Teacher OASIS: International treatment program for refugees and torture victims. Copenhagen, Denmark.

1987-1990 - Guest teacher for the Danish Psychiatric hospitals at Nykooping and Viborg, Denmark.

1987-1989 - Guest Teacher, Bodynamic Institute. Copenhagen, Denmark.

1986-1990 - Consultant, Hopi Guidance Center; clinical training for native therapists.

1985-1989 - Co-teacher with Richard Oiney M.A., Hypnosis and Body Experience, a series of professional residential training programs held in Arizona.

1980-1990 - Program director and primary teacher in the Somatic Experiencing training program for Body Oriented Therapy, Berkeley, California.

1985-1987 - Community Affairs co-director for Ergos Institute, Flagstaff,-Arizona.

1985-1986 - Stress Consultant for Sheriffs Department of Coconino County, Arizona.

1984- Antioch College, San Francisco, California, Faculty in Somatic Psychology.

1983- Teacher in Residence and Director of the Extended Study Program, Esalen Institute. Big Sur, California.

1981-1982 - Visiting Faculty, University of New England, College of Osteopathic Medicine - Department of Clinical Principles and Practice. And Continuing Medical Education.

1981-1982 - Consultant, Blueberry Treatment Centers for Autistic Children, Brooklyn, New York, with Dr. Mira Rothenberg.

1980-1981 - Consultant, Stress and Pain Center, Victoria, British Columbia, Canada.

1978-1979 - Consultant to NASA Ames: Stress Factors in Space Shuttle Flight (Project Director; U.C. Consortium with NASA.)

1978-1979 - Instructor, Antioch College, San Francisco.

1977-1979 - Lecturer, Department of Health and Medical Sciences, University of California, Berkeley.

1976-1977 - Field Facility Advisor for Humanistic Psychology Institute Saybrook University, San Francisco, California.

1970-1971 - Lecturer in Contemporary Natural Sciences Program, Department of Physics and Zoology, University of California, Berkeley.

1969-1970 - Instructor (acting): Zoology, University of California, Berkeley.

1969-1970-Instructor: Life Sciences, Mills College, Oakland, California.

1962-1964 - Research Assistant, Electronic Defense Group and Department of Psychology, University of Michigan with Professor Wilson P. Tanner on electronic prosthetic devices for the blind.

1961- Technical Assistant, Bell Telephone Laboratories, Murryhill, New Jersey with Leon D. Harmon in Neurocybernetics, ''Artificial Neuron'' Project.

1961- Research Assistant Department of Psychology with Professor P.M. Fiffs, Stimulus Response compatibility studies in Human Engineering.

PUBLISHED WORKS
1999- Healing Trauma-Restoring the Wisdom of the Body, Peter Levine; Sounds True

1998- Trauma Therapy for Survivors of Torture, Jorgensen and Mathiasen eds.

1997-Waking the Tiger-Healing Trauma, Peter Levine with Ann Frederick; North Atlantic Books

1997- Memory, Trauma, and Healing- article appeared in Spring, 1997 of AHP Journal Perspective. Also in the Journal of Bio-Synthesis.

1996- ''Understanding Childhood Trauma''

1991- ''The Body As Healer, Transforming Trauma''

1990- Revisioning Anxiety and Trauma, in Giving the Body Its Due (ed. Maxine Sheets Johnstone) S.U.N.Y. Press, 1991.

1989- The Substitute Tiger, An Integrative Bio-developmental Approach to Anxiety and Post Traumatic Stress.

1986- Chapter on Stress for Psychophysiology. Systems, Processes, and Application, A Handbook, eds. Coles, M., Donchin, E., and Porges, S., Guilford Press, 1986.

1983- Chronic Perinatal Stress as a Predisposing Factor in Autism and Childhood Psychosis, a Neurodevelopmental model suggesting strategies in treatment and prophylaxis. In: Symposium on Autism co-sponsored by University du Quebec a Montreal and San Francisco State University.

1982- Circle of Damage, Circle of Grace-Stress and Your Children. (Unpublished Manuscript).

1982- Stress, Neurobiology and Behavior Benchmark series on Human Physiology and

Behavior, Dowden, Hutchinson and Ross, Inc. (Submitted for Publication).

1978- Stress and Vegetatherapy, Journal of Energy and Character-England (Fall and Winter)

1978- Infra-Uterinee Environment, Stress and Neurological Development, Journal of Behavioral Neuropsychiatry.

1977- Accumulate Stress Reserve Capacity and Disease, University Microfilm 77-15760, Ann Arbor, Michigan.

1977- A Rhythm to Growing. - A Comment on the Body Approaches of Reich and Rolf and the Process of Adaptive Growth, Life and Works of Wilhelm Reich, Viking Penguin.

1964- A Model for Flicker Fusion. Bell Telephone Company, Technical Memoranda.

CONFERENCE PRESENTATIONS
1999- Keynote Speaker, National Institute for the Clinical Application of Behavioral Medicine, Palm Springs, California.

1996-1999 - Keynote Speaker, American Polarity Therapy Association

1999- The Biology of Emotion- With Candice Perts.

1997- Keynote Speaker, Trauma Conference, Naropa Institute

1997- Keynote Speaker, Oasis Tenth Anniversary, International Conference, Copenhagen, Denmark.

1997- Keynote Speaker, International Polarity Conference

1996- Keynote Speaker AHP (Assoc. of Humanistic Psychology) International Conference

1995-1998 - Keynote Speaker The International Somatics Congress-Congress International de Somatotherapy

1995- ''Unifying the Elusive Symptoms of Post-Traumatic Stress and Closed Head Injury; New Models for Treatment''-Rehabilitation in-service, Mapleton Center/Boulder Community Hospital

1991- ''Somatic Contributions to the Healing of Sexual Abuse.'' University of California Extension School of Public Health.

1991- ''What Is The Child's Reality?, The Child In the Hospital,'' Washoe Medical Center, Reno, Nevada.

1990- Keynote National Hakomi Institute of Body Oriented Psychotherapy.

1989-1990 - Keynote National Guild for Structural Integration.

1989- ''The Ordinary Miracle of Healing'' at Washoe Medical Center, Reno, Nevada.

1989- ''An Integrative Approach to Anxiety and Post-Traumatic Stress.'' The Second Nordic Psychophysiology Conference, Lynkooping, Sweden.

1988- Keynote National AMTA - ''Body Feeling and Self''

1987-1988 - Grand Rounds, Nevada-Mental Health Institute and the Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Nevada, Reno.

1. ''What Constitutes Therapeutic Milieu in a Hospitalized Setting?'' (A panel discussion).
2. ''Body/Mind Relationships; A Synthesis of Developmental and Psychophysiological Approaches in the Non-drug, Somatic (body-oriented) Treatment of Psychopathologies''
3. ''The Substitute Tiger; Shock as a Critical and Neglected Factor in Treating Phobic States and Other Psychopathologies.'' Reno, Nevada.

1987- ''The Body in Health Care.'' YWCA, Reno, Nevada.

1984- ''Beyond the Relaxation Response: Self-regulation and Healing for Clinicians.'' U.C.L.A. School of Medicine.

1983- ''Towards a Biology of Body Work.'' Keynote Speaker. New Visions in Bodywork Invision Associates and JFK University.

1982- Grand Rounds, Pacific Medical Center (Department of Psychiatry): ''Another Look at Carbon Dioxide Inhalation in the Treatment of Stress Underlying Various Pathologies.''

1982- ''The Body and the Person: Towards a Somatic Model of Health'' (U.C. Extension School of Public Health), Consultant, Coordinator, and Participant.

1981- ''The Perinatal Period: Interface of Biology and Behavior'' (with S. Porges). Esalen Institute, Coordinator and Participant.

1980- ''Conceptualizing Energy Medicine.'' (U.C. Extension School of Public Health).

1979- ''Biology of the Affectional Bond.'' University of California, Berkeley, Health and Medical Sciences; Stanford Research Institute International: Ergos, Foundation, and Esalen Institute; Coordinator and Participant.

PROFESSIONAL SOCIETIES
American Psychological Association
A.M.T.A.-American Massage Therapy Association
Guild for Structural Integration-inactive
Society For Clinical and Experimental Hypnosis

CERTIFICATIONS
American Board of Medical Psychotherapists, Fellow and Diplomat
American Board of Stress Practitioners
American Council of Hypnosis Examiners
The American Institute of Stress, Fellow and Diplomat
ISSSEEM-International Society for the Study of Subtle Energies & Energy Medicine

Bessel van der Kolk, M.D.

Bessel A. van der Kolk M.D. is Professor of Psychiatry, Boston University School of Medicine, Medical Director, the Trauma Center, Boston, MA, Past President, the International Society of Traumatic Stress Studies. He is the author of Psychological Trauma and an editor of Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society. Dr. van der Kolk is one of the pioneers in traumatic stress studies. He was co-principal investigator of the DSM IV Field Trial for Traumatic Stress. He has written over a hundred scientific research articles on the topic and two leading textbooks. He has taught across the US, in Europe, China, Japan, Israel, South America and South Africa. His current research focuses on 1) Memory functions in a range of traumatized populations, including children exposed to violence, post-surgery patients, and torture victims; 2) The effects of theater groups and other action- oriented interventions on resolving traumatic stress in children and adolescents 3) Functional changes in brain activity, utilizing various neuroimaging techniques. 4) Treatment efficacy of EMDR vs. pharmacological agents, funded by the National Institutes of Mental Health.

Edward Tick, Ph.D.

Edward Tick, Ph.D., is an expert on post-traumatic stress disorder. A practicing psychotherapist for more than 25 years, he is a nationally recognized authority on the psychological, spiritual, historical, and cultural aspects of war in the healing of PTSD. Dr. Tick specializes in transformational work with war veterans and all survivors of severe trauma, including sexual and substance abuse victims, those with acute mental and emotional disorders, and those in need of deep psycho-spiritual healing. Dr. Tick applies his own innovative model of treatment based on his research of worldwide spirituality, mythology, traditional cultures, and the warrior archetype in order to develop a new and strengthened psycho-spiritual identity.

A writer, educator, and overseas journey guide, Dr. Tick holds an M.A. in psychology from Goddard College and a Ph.D. in Communication from Rensselaer Polytechnic Institute. He is a clinical member and has held various positions with the American Academy of Psychotherapists and the American Holistic Medical Association, as well as many other professional organizations. He is an ordained interfaith minister.

In 1979, Dr. Tick began psychotherapy treatment of Vietnam veterans before PTSD was a diagnostic category. Since that time, he has treated veterans and survivors of WWII, the Holocaust, Korea, the Vietnam War, the Gulf War, Central American conflicts, Lebanon, the Balkan wars, the Irish civil and religious wars, the Greek Civil War, the Middle East conflicts, and the Iraq War. He has also served as a consultant to numerous community and church organizations for the treatment of veterans and has participated in the training of staff.

Dr. Tick’s extraordinary work takes him on healing journeys, spiritual tours, lectures, educational classes, and workshops around the globe. He is co-founder of the Sanctuary International Friendship Foundation, a nonprofit agency that directs and raises funds for projects to help heal war-torn Viet Nam. He resides in Albany, New York, where he and his wife Kate Dahlstedt are directors of Sanctuary: A Center for Mentoring the Soul and Soldier’s Heart, a non-profit program designed to create safe-return programs for veterans in communities across the country.

The author of three other books, Dr. Tick recently released War and the Soul: Healing Our Nation’s Veterans from Post-traumatic Stress Disorder (Quest Books, Nov. 2005), which has gained much international attention and acclaim. The title is now being used as the guidebook for Soldier’s Heart®, giving new hope to the devastation of war and showing us how to welcome home our soldiers with compassion and understanding. War and the Soul is the winner of the 2006 Award of Distinction from the International Communicator Awards program and has won ForeWord Magazine’s 2005 Book of the Year Award (BOTYA) in psychology. For more information on Dr. Tick and his work, visit his Web site, linked here.

Robyn D. Walser, Ph.D.

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

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

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

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

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

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

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

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

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

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

Thanks to Kathie Costos for this reference...

Floyd "Shad" Meshad, MSW

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

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

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

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

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

(More information follows, from a separate bio)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

 

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

 

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

 

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

Finding a Qualified Attorney to Represent You

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

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

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

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

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

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

Another Expert's Quotable Quote on PTSD

A great quotable quote from PTSD expert, Frank M. Ochberg, M.D., who once said: "PTSD is a medical condition.  The most important thing we can do to help our loved ones with PTSD is to be the most informed person on your block about PTSD."

Professor Hedley G. Peach (Australia)

BSc(Hons) (Wales), MBBCh (Wales) PhD(London), FFPH(UK)
University of Melbourne

(Retired) Professor, School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland, AUSTRALIA.

Professor Hedley Peach is a Visiting Consultant at the Ballarat Base Hospital, and Professional Fellow at the University of Melbourne.

Professor Hedley Peach qualified as a doctor in Wales where he became interested in the social causes of illness. This interest led him to train in community medicine at the renowned St. Thomas's Hospital in London where he worked for seven years as a lecturer/senior lecturer. In 1985 he migrated to Australia where he was Foundation Professor of Tropical Health at James Cook University for three years and, subsequently, Professor of Community Medicine at Melbourne University for fourteen years. He retired earlier this year but continues as an honorary Professorial Fellow of Melbourne University. He has been interested in the nexus between religion, spirituality and health for a number of years. In 2002, he wrote the first article on this topic to appear in the Medical Journal of Australia to stimulate debate on how the medical profession should respond to research and recommendations from the USA. He has authored book chapters and papers on spirituality and women's health, the religions of rural Australians, and other topics. He has given many radio and newspaper interviews on spirituality and health. He is the author of several books, including The Epidemiology of Common Diseases and Disablement in the Community, as well as the leading author of more than 100 articles in scientific journals. He is a member of the National Heart Foundation's expert group on psychosocial causes of heart disease.

Elspeth Cameron Ritchie, M.D.

Elspeth Cameron Ritchie, a colonel in the United States Army, holds a master's degree in public health and a medical degree. She trained at Harvard University, George Washington University, Walter Reed Army Medical Center, and the Uniformed Services University of the Health Sciences, where she is an associate professor of psychiatry. Her assignments and other missions have taken her to Iraq, Israel, Korea, Somalia, and Vietnam. She brings a unique public health approach to the management of disaster and combat mental health issues and is internationally renowned as an expert on the subject. She also has published numerous articles on forensic, disaster, and military operational psychiatry. She is the recipient of the William Porter and Bruno Lima awards. Ritchie is currently the psychiatry consultant to the US Army Surgeon General. She is also the author of "Interventions Following Mass Violence and Disasters: Strategies for Mental Health Practice."

Kathie Costos, Chaplain

Kathie Costos, also known as "Nam Guardian Angel," is a certified, ordained Chaplain and member of the International Fellowship of Chaplains ("IFOC").  The daughter of a Korean War veteran, and the wife of a Vietnam veteran, she has been active in veterans issues since the 1970s.  For the last 25+ years, she has focused on Vietnam veterans with Post-Traumatic Stress Disorder.

As a chaplain with a devout Greek orthodox background, Kathie nevertheless believes that "no matter what church people belong to, they belong to the family of God as God's children."  Years of volunteering with Vietnam veterans and their families has taught her to take care of the spiritual needs of people and not just the already "faithful."

Kathie is the author of a well-regarded book, called For the Love of Jack, His War/My Battle -- about how her family coped with the legacy of PTSD that her husband returned with from the Vietnam War.  She self-published the book immediately after 9/11, out of concern that the word needed to get out about what PTSD was, before many more people began to suffer from it.  The book is available for downloading on her website, and Kathie has also produced many educational videos about PTSD that are also available on her website.  A list of those videos include the following, but because Kathie is always expanding the list of videos she's made about this topic so close to her heart, it also makes sense to "favorite" her on YouTube, where a list of all her videos is linked, here.  A list of those videos current as of this writing include the following (each is hyperlinked to YouTube or Google video, so you can watch them directly):

• Wounded Minds: PTSD and Veterans (Google)
• Coming Out of the Dark: PTSD and Veterans
• When War Comes Home, Part One
• When War Comes Home, Part Two
• Hero After War
• Death Because They Served - PTSD Suicides (Google)
• Wounded and Waiting, Part One
• Wounded and Waiting, Part Two
• Women At War
• The Voice, Women At War
• Nam Nights Of PTSD Still
• PTSD After Trauma
• PTSD Not God's Judgment
• Homeless Veterans Day

A link to Kathie's website about PTSD is here.  For a direct link to the book she wrote about her husband and family surviving PTSD, click here. For a link to her ever-expanding list of videos about PTSD and veterans, click here.

A favorite quote of Kathie's: "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.

William P. Nash, M.D.

William P. Nash, M.D., is an active duty Captain in the U.S. Navy Medical Corps, with nearly thirty years of active military service. He is a graduate of the University of Illinois, College of Medicine, in Chicago, and of psychiatry residency training at Naval Medical Center, San Diego. In addition to leading two Navy SPRINT crisis response teams, he has directed two Navy psychiatry residency training programs, and has served as the Director of Clinical Services of the hospital ship USNS MERCY. CAPT Nash has been stationed with the Marine Corps since 2000, including deploying to Iraq in 2004 with the 1st Marine Division as a psychiatrist embedded with ground combat forces. He was awarded a bronze star medal for his service in Iraq in support of combat operations there. Since October, 2005, CAPT Nash has been stationed at Headquarters, Marine Corps, in Quantico, Virginia, where he directs and coordinates combat/operational stress control policies and programs for the United States Marine Corps. He is an Assistant Clinical Professor of Psychiatry at the University of California, San Diego, and has co-edited a book with Charles R. Figley, Ph.D., released in late 2006, entitled Combat Stress Injury.

Georg-Andreas Pogany

Georg-Andreas Pogany is a retired Sergeant First Class (SFC) and Operation Iraqi Freedom Veteran. After obtaining a bachelor's in criminology from the University of South Florida, he enlisted in the U.S. Naval Reserve. In 1998, he switched services and enlisted in the Army, where he trained as a nuclear, biological and chemical warfare specialist. In 2003, he was deployed to Iraq as part of a Special Forces unit. There, he became incapacitated by toxic drug levels from the anti-malarial drug Lariam/Mefloquine. He was sent to Fort Carson, Colo., where he was diagnosed with a related brain injury. He received treatment and shortly thereafter was honorably discharged.

Since his retirement from the Army, he has worked as a veteran's and active duty service member advocate on health care, combat stress, and military justice. He created and manages "J1W2," Just One Wounded Warrior, which connects veterans and active duty service members with mental health care professionals.

Barbara V. Romberg, Ph.D.

Barbara V. Romberg, Founder and Executive Director of Give an Hour, is a licensed clinical psychologist who has been practicing in the Washington, D.C., area for 16 years. She specializes in the diagnosis and treatment of children.

Dr. Romberg has spent her career interacting with and coordinating services within large systems, including school districts and mental health clinics. In addition, for many years, she served as an adjunct faculty member at George Washington University, where she trained and supervised developing clinicians. She received her PhD in clinical psychology from the University of Maryland in 1991.

Concerned about the mental health implications of the Iraq War, Dr. Romberg founded Give an Hour in 2005. Give an Hour is a nonprofit organization that is creating a national network of mental health professionals who are providing free services to U.S. troops, veterans and their families.

Editor's note: For a link to Give an Hour, click here.

Jennifer J. Vasterling, Ph.D.

Jennifer J. Vasterling serves as the Chief of Psychology at the VA Boston Healthcare System and as a clinical investigator within the Behavioral Sciences Division of the National Center for PTSD.

Dr. Vasterling also is a Clinical Professor of Psychiatry and Neurology at Tulane University School of Medicine. She obtained her PhD in clinical psychology from Vanderbilt University in 1988. Trained as a clinical neuropsychologist, Dr. Vasterling's research has centered on furthering understanding of the cognitive and emotional changes that accompany war-zone deployment and post-traumatic stress disorder.

Her recent work includes a longitudinal study examining neuropsychological and emotional outcomes of the Iraq War. This effort is unique in that it tracks the mental health of deploying soldiers, starting when they are deployed and following them after they return from Iraq.

Charles R. Figley, Ph.D.

Charles R. Figley, Ph.D. is Director and Professor, Florida State University Traumatology Institute, and Editor of Traumatology (Sage Publications). He has published nearly 200 scholarly papers and 19 books since 1973. His first book, Stress Disorders among Vietnam Veterans: Theory, Research, and Treatment (Brunner/Mazel, 1978), is recognized as the first comprehensive analysis of the immediate and long-term psychosocial consequences of war on the combatants. This was followed by Strangers at Home: Vietnam Veterans since the War (Praeger, 1980). His latest book, with Navy Captain and psychiatrist William Nash, is Combat Stress Injury (Routledge, 2007). He is a former Vietnam veteran and Marine who has worked closely with all branches of the military to help combatants and their families and those who care for them (corpsmen, medics, nurses, physicians, social workers, psychologists, chaplains, and their superiors who evaluate them). The Green Cross Academy of Traumatology, which he founded in 1995, is working with other NGOs to help returning veterans and their families.

For a link to Dr. Figley's home page at Florida State University, click here.  For a downloadable copy of his c.v., click here.  For a link to the Traumatology journal, click here.

Jonathan Shay, M.D., Ph.D.

Jonathan Shay, M.D., Ph.D. has been a staff psychiatrist at the Department of Veterans Affairs Outpatient Clinic, Boston since 1987, where his only patients have been combat veterans with severe psychological injuries. In 2007, he was awarded a MacArthur Foundation "genius grant" for his work with veterans.  Shay is the author of Achilles in Vietnam: Combat Trauma and the Undoing of Character (1994) and of Odysseus in America: Combat Trauma and the Trials of Homecoming (2002), the latter of which has a foreword authored jointly by US Senators John McCain and Max Cleland.

Between September 1, 2004 and August 31, 2005, Dr. Shay was Chair of Ethics, Leadership, and Personnel Policy in the Office of the US Army Deputy Chief of Staff for Personnel, and earlier was Visiting Scholar-at-Large at the US Naval War College (2001) and performed the Commandant of the Marine Corps Trust Study (1999-2000).

Jonathan Shay received a B.A. (1963) from Harvard University and an M.D. (1971) and Ph.D. (1972) from the University of Pennsylvania.  For a link to his bio on the MacArthur Foundation site, click here.  For an interesting bio of Dr. Shay that was published some years ago in the New York Times, go here. 

Fred D. Gusman, M.S.W.

Mr. Fred D. Gusman, M.S.W. is an internationally recognized figure in the mental health field. Mr. Gusman's expertise in the arena of traumatic stress is based on the firm foundation of his own military service coupled with his 30 years of clinical, research, and consultative experiences in the field of traumatic stress, combat stress, PTSD, disaster mental health services, and mental health programs development. He is an expert educator, clinician, program administrator and developer, and is a frequently sought after consultant to those in the field of traumatic stress. His knowledge base is informed by a noteworthy career and varieties of roles and experiences. Mr. Gusman pioneered and developed the nation's first residential rehabilitation programs for men and women veterans at the Veterans Affairs Palo Alto Health Care System (VAPAHCS). Under his vision, guidance, and leadership, the programs have served thousands of veterans during the course of the last thirty years. In addition to this role, he has been called upon to serve in diverse capacities for the Department of Veterans Affairs, National Institute of Mental Health, Department of Defense, American Red Cross, Federal Governmental Committees, in numerous community and state programs throughout the country and in Europe, and in numerous natural and man-made disasters, e.g. September 11th terrorist attack on the Pentagon). During the last two years, Mr. Gusman has provided numerous consultations and clinical trainings to various branches of the Department of Defense such as: Marine Corp Community Services (MCCS) staff and Marine Corps Family Services staff (various US mainland sites); the National Guard (Hawaii's 29th Infantry Brigade) and their families, and; Army personnel at Hawaii's Schofield Barracks-Soldier Retransition Center and the Family Retransition Center. Finally, Mr. Gusman is a collaborator on various research studies and author/co-author of numerous research and clinical publications.

Raymond Monsour Scurfield, DSW, ACSW, LCSW

Dr. Scurfield is Professor of Social Work, Director of the Katrina Research Center and President of the Gulf Coast Faculty Council, University of Southern Mississippi Gulf Coast.  He was the 2006 Mississippi NASW social Worker of the Year for his post-Katrina efforts, and he continues to provide counseling at the University of Southern Mississippi Gulf Coast to students, faculty and staff. His MSW and DSW are from the University of Southern California.  He was a social work Army officer on a psychiatric team in Vietnam (1968-69) and has co-led return trips to peace-time Vietnam in 1989 and 2000.

Previously, Dr. Scurfield had a 25-year career with the Department of Veterans Affairs in which he directed several regional and national Post-traumatic Stress Disorder (PTSD) programs from Washington, DC to Tacoma, WA, to Hawaii and American Samoa. He has over 60 publications, has been PI or Co-PI in several PTSD research studies, has given over 350 presentations in the U.S. and abroad and has made numerous media appearances, to include 60 Minutes, Nightline, Nightwatch, National Public Radio and numerous NPR-affiliated radio stations nationwide. Dr. Scurfield has been active in post-disaster interventions and is a certified Compassion Fatigue Educator and Compassion Fatigue Therapist. Dr. Scurfield’s most recent writings are about post-Katrina interventions on the Mississippi Gulf Coast. His November, 2004, book was the first book in a series, A Vietnam Trilogy. Veterans and Post Traumatic Stress, 1968, 1989 & 2000. The second and third books in the trilogy were published in 2006: Healing Journeys. Study Abroad with Vietnam Veterans, and Volume 3, War Trauma. Lessons Unlearned From Vietnam to Iraq that describes over 30 unlearned lessons about war, its impact and what to do about it.

To download Prof. Monsour's CV, click Download raymond_monsour_scurfield.doc .

Darrah Westrup, Ph.D.

Darrah Westrup, Ph.D., is a clinical psychologist living and working in the San Francisco Bay Area. She received her degree from West Virginia University and completed two years additional training in behavioral medicine at the Department of Psychiatry and Behavioral Sciences at Stanford University Medical Center. She is currently working as attending in the Women's Trauma Recovery Program at the National Center for PTSD, and is the program director of the Women's Mental Health Center, VA Palo Alto Health Care System. Westrup also maintains a private practice based in Menlo Park, CA. She has clinical and research expertise in the areas of PTSD, substance abuse, stalking behavior, and experiential avoidance as it relates to psychological dysfunction.

Darrah Westrup, Ph.D., is one of the co-authors of Acceptance & Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder: A Practitioner's Guide to Using Mindfulness & Acceptance Strategies.  Oakland, CA: New Harbinger Publications (2007).

Commander Beverly Dexter, Military Psychologist

Commander Beverly Dexter, Ph.D., is an Active Duty U.S. Navy Psychologist who has served three tours with Marines in the U.S. and Iraq.  She is a warfare qualified former Navy Special Operations Officer (salvage diver and ship driver) and former Navy Supply Corps Officer.  She completed operational tours on four Navy ships and frequently gives professional military presentations on leadership, resilience building for military families and prevention and treatment of trauma.  CDR Dexter has lived military life as a single person, double active duty couple, "dependent" wife and mom, deployed mom, stationed overseas and deployed to a combat zone.  She is the Founder and Chairman of the EMDR International Association Military Special Interest Group and the ISTSS Military Special Interest Group.  Dr Dexter is a leader in the effort to improve trauma treatment for Active Duty, Reservists, and National Guard returning from combat and for their families, and has considerable experience serving Army National Guard troops in Iraq.  Dr Dexter is EMDRIA Certified in EMDR and a Fellow and on the Speaker’s Bureau of the American Academy of Experts in Traumatic Stress.  Author of the forthcoming book, No More Nightmares:  How to Use Planned Dream Intervention to End Nightmares (scheduled for release in 2008), she has taught her original theory of Planned Dream Intervention to thousands of individuals who have experienced rapid resolution of recurring dreams and nightmares.

NPR Story on Jonathan Shay, M.D., Ph.D.

Following up on our coverage of Jonathan Shay, M.D, Ph.D., winning his well-deserved MacArthur Foundation "genuis grant," NPR did a nice story this week on Dr. Shay as well.  Click here to read or listen to the story.  There's also an audio file of Dr. Shay discussing how a scene from the Odyssey "relates to soldiers back from Iraq today."

Jonathan Shay, Combat Trauma Expert

A wonderful profile that's still on the Web is the one profiling prolific combat trauma expert Jonathan Shay, M.D., in the New York Times from 2003.  Click here to find it on its website.  Shay is a towering figure in the field, having written several of the pre-eminent works (see sidebar), and the profile tells an interesting story of the turns Shay's own life took leading him to the study of combat trauma, and helping veterans survive the turmoil of their post-combat lives.  (Shays' books include "Achilles in Vietnam: Combat Trauma and the Undoing of Character," and "Odysseus in America: Combat Trauma and the Trials of Homecoming."