Healing Combat Trauma

A Look in "The Mirror" -- Great Britain Seeing War Trauma Now in 3 Years, Not 13 As Before

Because Americans are notorious for paying little attention to things that happen elsewhere, even among other English language-speaking countries, here's some news from Great Britain's tabloid-esque "The Sunday Mirror" today about their soldiers' battles with PTSD on the homefront -- soldiers who served in Iraq and Afghanistan.  For the link to the article, called "War's Silent Victims," by Rupert Hamer, click here. (The tabloid nature of the newspaper explains the fairly breathless writing style, but let's hope the facts and the reporting are accurate nonetheless.)

Points worth mentioning from the article include:

"Alarmingly, the charity [Combat Stress, see below] say[s] the figures are just the "tip of the iceberg" and add that the rate at which soldiers are developing the condition has accelerated. Usually it takes 13 years for cases of post-traumatic stress disorder to develop in veterans.

But psychiatrists at Combat Stress's pioneering centre say the men and women now being treated have come forward after just THREE years.

Also:

Dr Walter Busuttil, a consultant psychiatrist at Combat Stress, said: "What we are seeing now is just the tip of the iceberg.

"Because there has been no proper study of post-traumatic stress disorder among troops in this country we have no idea of the true scale of the problem.

"The same thing happened in the US after Vietnam. The Government tried to dismiss the disorder as a myth - then the whole thing exploded. Now when I speak to my colleagues in America they tell me: 'You are going through your Vietnam'."

And finally:

Dr Busuttil, 49, a psychiatrist in the RAF for 16 years, says the Government has covered up the severity of the conflicts from the public.

"The worst thing for a serviceman or woman is to come back from a war and for people not to have any idea what they have been through.

Editor's note: For a link to Great Britain's charity, Combat Stress, click here.  To find them on Facebook, click here. We've written about them before on this blog, but according to their website, "Combat Stress is the leading charity specialising in the care of British Veterans who have been profoundly traumatised by harrowing experiences during their Service career and who are suffering from poor mental health as a result."

When the Marine Corps Misses the Bigger Picture -- Zoriah, Eric Acevedo, and Censorship

It's discouraging to even have to post about this, but there it is.

In a fight between the Marine Corps and freedom of the press, the Marine Corps seems like it wants the win.  According to Google Playfights (see gimmicky graphic illustrating this post) it already has.  (Learn more about Google Playfights elsewhere: it's not central to this post.)

Following the recently embedded independent photojournalist Zoriah's travails recently, on his blog, it seems he's being kicked out of Iraq, and risking being completely blacklisted, because of at least some higher up Marine Corps officers displeasure with images he posted.  Images that centrally could help America to really get a better grip on the true cost of war for its participants.  If you believe the experts (and the poets), no one comes back from war, unchanged.  Whether it's what you've done/seen/participated in or not been able to do/see/participate in, it exacts a tremendous psychic cost.  That doesn't mean we should stop fighting in them - just that we should be more aware of the actual costs.  For every combatant killed, so many more are injured, and will come home with injuries that in many cases will profoundly transform their lives, and that of their families, for decades to come.  It's a shame the Marine Corps doesn't really want to let us, Americans, wrap our brains around this concept more fully.  It would help make us better empathizers with the true cost of war to its participants.

I had my own experience with Marine Corps censorship, earlier, on this blog.  In an attempt to humanize the story of an apparent PTSD sufferer who'd killed his girlfriend, I dug through the Marine Corps (public) archives on their website, and found a little backstory about the Marine, Eric Acevedo, who'd been accused of the crime.  In and amongst the materials were some very key items: a photo that showed the human side of his grief and pain; and some material -- if you knew where to look -- that explained just what he'd been exposed to, in terms of combat trauma, while he was on the deployment that apparently harmed him the most.  It was a tragic tale, but it was public knowledge -- at least, information accessible by the public, that could be pieced together by someone like a journalist, who knows how to dig, and highlight the important parts of the story.  I posted what I found, in an entry linked here -- and within three days, the Marine Corps had taken pains to scrub ALL identifying information about this poor guy, Acevedo, from their site.  The photo was gone, the article about the memorial service he attended, for the multiple guys KIA from his battalion on the tour in question -- all gone.  I learned about this new development when a reporter from the Dallas Morning News contacted me and said that all my links were down (I'd included them in the original piece, so anyone could follow and see what my sources had been).  Together, we backtracked through the Marine Corps archives, and found NOTHING -- the site had been scrubbed clean of multiple mentions of the accused -- and has stayed that way, since then.

Nobody likes bad publicity, but really, there's so much more at stake than that.  When it comes to combat trauma and PTSD, the focus of this blog -- it's important as a society that we see, learn, and otherwise come to understand what veterans go through -- or we won't have the compassion that we need to, and we won't pull for them to get the services they deserve, otherwise.  We also need to see more clearly the link between instances of combat trauma, and ultimately developing PTSD.   Not so "no one else will join the military" -- not at all.  So that those who do can get the help they need, and those in charge will allocate their resources accordingly.

It's my firm conviction that combat veterans don't "give" PTSD to themselves.  They "get" it from what they've experienced.  And this is a true cost of war, for the Marine Corps and others to "count" in advance, so that the right opportunities for treatment and ideally recovery can be provided.  We can see from the late SSgt. Travis Twiggs' battle with PTSD -- or many others like him -- just how powerful, thorough, and deadly an opponent it really is.  What we're not seeing, unfortunately, from the Marine Corps -- in these two instances -- is a reasonable, big picture view on how the horrors of war are not something the American public needs to shy away from, but embrace.  And where the two may be linked up, as in the Eric Acevedo story, it's crucial that the Marine Corps not distance itself from its warriors, even when they're dented with significant wounds, visible and invisible. Sanitizing war?  Why bother... Actually supporting the troops who go? Oh, definitely.  If knowledge is power -- we need more, not less - in order to do so, more effectively.

In the Zoriah situation, it sounds like someone may have snapped under the strain and started a bad ball rolling with that -- created a polarized position that no one could retreat from, gracefully.  If that's the case, that's a real shame.  There's a much bigger picture here, and finding a workable compromise would be greatly important.  I remember reading one Marine officer's published dispatches from Iraq, which got progressively darker and unpleasantly snappier as his tour went on, to the point that it sounded like another person writing them.  I commented about this to someone who knew that Marine, who told me a little side story that explained a lot.  Things had been going well until that Marine's superior, to whom he was very close, was seriously injured and almost died, taking part in a humanitarian mission with the Iraqi government.  At that point, the junior officer hit a wall, got bitter, and got very angry with the Iraqis who could have done that, while the Americans were just trying to help.  What I had been picking up in the Marine officer's writing reflected the personal struggles he was genuinely going through -- struggles which are highly understandable to anyone interested in human nature.  My guess is here, someone who felt very stressed and angry because of Marines he cared about being injured and dying, snapped down on the whole situation instead of privately (or publicly) processing his natural grief -- and the ultimate impact might be, if this continues to go wrong, to keep the rest of us from being able to experience war a little bit more, even vicariously - in order that we better understand, and grieve, with those who suffer.  I hope the Marine Corps finds a way to resolve this situation that respects the points of view of all sides involved, including the American public, which does have a need to know.  The same goes for the Eric Acevedo situation, and scrubbing the information from their archives.

The American public pays the bill for these wars: we have a right to know what they're like for those fighting them.  And those who fight them pay the ultimate price: and we respect their efforts and the character it takes to be warriors, very much.

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I shared a very bleak, grim quote with a Marine Corps Vietnam vet the other day, from an Italian in the Middle Ages who said, "Life is a voyage on uncharted waters, ending in shipwreck.  There are no survivors."  The former Marine, still struggling all these years later with PTSD, said the quote was almost right, but would be better if we switched out "life" with "combat" or, "war."  Then, he said, it would be more accurate, because, quoting him, there are no true "survivors, only shipwrecked lives..."

Editor's Note: You can read about Zoriah's developing situation on his blog, linked here.  You can also read previous entries on this blog where we've mentioned him, here and here.  You can read about the Travis Twiggs story here, and in many other entries on this blog; and the Eric Acevedo story here; both as I've blogged about them. 

And while you're at it, considering asking the Marine Corps to put the Eric Acevedo material (and anyone else's they've removed, in similar circumstances) back on their publicly-searchable archives, as it was before.  I'm sure his defense lawyer would appreciate it, because any good defense of this client is going to need to advance theories that involve his extenuating circumstances (combat) and things that speak to his state of his mind (PTSD), both of which it's hard to picture were NOT service-related.  Acevedo's crime?  A  truly terrible one.  The combat trauma he experienced, and the PTSD he likely developed?  Also terrible.  Without war coverage like Zoriah's "tragic and amazing" photography, also a big picture we're likely to miss.

The Blunt Truth: Combat Veterans, PTSD and Medical Marijuana

There's a great article on the Web from the Salem (Oregon) News-Record of June 11, 2007, called "Marine Combat Vet Discusses Iraq, PTSD and Medical Marijuana," linked here.  The former Marine in question is Nicholas Burgin, and the subhead to the article is, "The courage of an Iraq War veteran continues in his honesty about PTSD."

In the tradition of Tony Neff's story, "All I Want is What I Deserve," about getting his veterans benefts for a service-connected disability, linked here, Nicholas Burgin's story is another great, first person narrative account of his experience, and what actually happened to him.  (We're in the process of seeing if we can get Burgin's permission to reprint his story in full, here, because it would help so many readers.)

In the meantime, read his story, while it's still up on the Web, or save yourself a copy of it, for future reference.  It's powerful.  And don't neglect reading the comments section, either, that follows the article.  A whole lot of people checked in and said they knew what he was talking about, and they agreed, from Vietnam vets through other OIF/OEF combat vets.

Burgin is a young Marine who, like a highly decorated Marine with PTSD we've blogged about here, Daniel Cotnoir, worked in mortuary affairs for the Marines in Iraq - a more gruesome job hardly exists -- and saw enough stuff to last a thousand lifetimes.  Later on, of course, Burgin had trouble with the memories, and despite trying everything recommended to him, found one and one thing only that helped him ease the pain.  He details his struggles, and his victories, in the excellent, first person narrative, and closes with the line, "Take what you will from this story, but I know for a fact marijuana has saved my life numerous times."  Good for him.

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In the 60s, draft dodgers and anti-war types in the U.S. made their way to Canada to ride out the Vietnam war.  Many stayed for years.  Today, with an all-volunteer military, "escaping" to Canada isn't nearly so popular; but if anyone compares the drug laws in the U.S. and Canada re: marijuana use, and finds themselves overly hassled by the perspective in the U.S. that it's still a criminal offense, they might start to find Canada more attractive again.  Depending on whether the party in power is liberal or conservative, their drug policy waxes and wanes, but more than 51% of Canadians are in favor of decriminalizing marijuna use, says the BBC, and using is often treated differently there than selling (possession v. intent to distribute).

Israeli Military's Proactive Plan for Identifying and Treating Soldiers Who Have PTSD

Here in the U.S., in our usual myopic way, we can get bogged down in the news about returning servicemembers with combat trauma and PTSD and forget just how many other countries in the world have struggled with this problem as well, and often found their own solutions.  Internationally, Japan, Israel, Australia, England and Canada frequently search the Internet for news about who's doing what, and what's working, for treating PTSD worldwide -- according to data from Google's analytical trends.  Today, the Jerusalem Post has an article about how Israel's Defense Ministry is about to unveil a plan for evaluating and treating soldiers systematically who have been exposed to PTSD as part of their military service.  (The article in question is linked here.)  Their expectation is that 2,500 Israelis suffer from PTSD, in a country where military service is compulsory, and conflicts in the region frequently boil over into sustained violence. 

The significance of the Israeli announcement is that the soldiers will be treated according to a "set psychological and medical format," meaning systematically and methodically.  Their understanding is that PTSD treatment succeeds better if initiated earlier, so evaluating all soldiers soon after military service will increase the chances of favorable treatment outcomes.  According to the article, three years ago the military started thinking through how to create a protocol that would involve every soldier, and optimize chances of finding and treating PTSD.  The protocol was developed by Zeev Waisman and Dr. Dan Dolfin.

Two interesting comments from the article express a vision that the U.S. might be wise to emulate:

"A soldier who comes out of battle will immediately be evaluated and we will see what type of treatment he needs," Waisman said. "Nothing is done today in a regulated fashion and we want all treatment to be according to a protocol."

The process begins by inserting the soldier's profile into the system which will then offer several courses for treatment that could include medicines, psychological therapy, family therapy, sex therapy and others. Waisman said that the Ministry of Defense hoped to convince other organizations to adopt the new format which will be evaluated in two years.

Stateside, it's not even clear that the various branches of the Armed Forces share a similar protocol for identifying and treating PTSD -- most likely, they do not.  With far more servicemembers at risk for PTSD than the Israelis have, we could do worse than to imitate what the Israeli Defense Ministry is putting into action as a plan to deal with PTSD, and return exposed servicemembers to better mental and emotional health.

British Soldiers Journey Back to Confront Ghosts from Combat Past

Because a percentage of our readership comes from abroad, and because the topic we cover is relevant internationally, today we note that the British press reported yesterday in two different articles how veteran combatants from the Falklands conflict are journeying back to confront the ghosts of their combat experience.  The Scotsman (Scotland) and the Guardian (England) both have articles on the subject, with much shared content between the two. 

The award-winning Guardian, consistently a great source of news and perspective, notes that "Two hundred and fifty Falklands war veterans - many still suffering psychological trauma from the conflict - will return to the islands this week. Their arrival and tour around local battlefields is timed to coincide with the 25th annual Remembrance Day Service [the British version of our Veteran's Day] since the 1982 Argentinian invasion." Furthermore, "among the former servicemen and women flying out are a group diagnosed with post-traumatic stress disorder (PTSD) who are hoping to exorcise the ghosts of the past."

The excellent Guardian also has new video they've created to honor the 25th anniversary of the war -- "watch the soldiers who were there relive their experiences and follow the war as it unfolded" -- and, if you're a history buff or just blank on what the Falklands War was all about, there's WIkipedia and this interactive guide on the Guardian's own site to clear up the confusion.

The Scotsman adds detail as well:

"SEVENTY former servicemen still battling with the psychological trauma of fighting in the Falklands War will fly to the islands today to face the ghosts of 25 years ago. The men, suffering post-traumatic stress disorder (PTSD), are among a group of 250 veterans from the 1982 conflict taking part in an anniversary pilgrimage to the battlefields in the South Atlantic.

For most of the men on the heavily over-subscribed [meaning, far more people signed up than were actually able to go] visit it will be their first time back since the British victory over Argentina.  The islanders - the population is less than 3,000 - are throwing open the doors to accommodate the party, including 15 relatives of those who died in the conflict, in their homes.  Organizers of the visit said that many local people have taken a week off work and offered their services as drivers for the party. One has even put a plane at their disposal to take them to outlying islands where they fought.

The event is being organized jointly by the main Falklands veterans body the South Atlantic Medal Association, and Combat Stress, the charity that works with ex-servicemen and women who are suffering psychological disabilities.  Combat Stress is providing around ten trained clinical support staff.

As well as those suffering PTSD many making the visit suffered major physical injuries such as losing limbs. Colonel Mike Bowles (retired), the chairman of the organizers, said: "Some of these guys did go through horrific experiences and saw horrific things. "I think going back and being able to be in a place and think about it and sit and maybe have some people around you, does help people come to terms with it."

But Col Bowles said the trip was also about seeing how the islands that they fought to liberate are thriving in 2007, and meeting the islanders themselves.  A total of 255 British servicemen and more than 600 Argentineans were killed in the war which ended the 74-day occupation of the islands.

Editor's Notes: (Highly miscellaneous.)  We've written about Combat Stress before.  See hyperlink.  It's the British variant on our term, combat trauma.  It's also the name of a service organization for combat veterans who suffer from PTSD in England. 

On a more serious note, notice how this event is happening 25 years after the conflict.  There seems to be a gigantic, painful lag in experiencing symptoms and confronting the past -- perhaps because of how painful it is, or how deeply the memories are buried.  This is consistent with our Vietnam veterans making trips back to Vietnam in recent years to confront the ghosts of their pasts there, and with decorated war heroes from that conflict, such as Max Cleland, who for many years headed the VA, taking 20+ years to realize that he was suffering from combat trauma himself.  In other words, it's likely to be a long, hard wait for veterans from Iraq and Afghanistan to be able to confront these experiences themselves, though we hope through many related efforts the cycle time is much shorter, for their sake. 

As Maxine Hong Kingston told me when I asked her how quickly vets were interested in writing (even for themselves) about what they'd gone through, she said that in her experience it had taken 20 years to come forward.  Perhaps that time from now on can be shorter -- but I think it underscores the gravity of the experience, and what these veterans have suffered, that it generally speaking takes that long.  Ouch.  Let's have as a goal, trying to close that particular loop, gracefully and graciously, with current veterans in a whole lot less time.

Children of War -- Traumatized

Great article in the Guardian today -- British paper -- about the generation of Iraqi children growing up traumatized by the current war.  Click here to read.  One quote from the article suffices: ""Sherif Karachatani, a psychology professor at the University of Sulaymaniya, said: "Every day another innocent child is orphaned or sees terrible things children should never see. Who is taking care of the potentially enormous damage being done to a generation of children?"

Canada's Only In-Patient Program for PTSD

An article from several years ago in the Psychiatric Times describes Canada's only in-patient program for PTSD sufferers.  The program, at a location called Homewood Health Centre, is located in Guelph, Ontario; and is modeled on a program in Philadelphia, PA., developed by psychiatrist Sandra L. Bloom, M.D., in the 1980s.

Combat Trauma in the UK

There's a sad story in the Scottish news website, ScotlandonSunday.com, about a severely-injured UK veteran of the Iraq war's experience back home in Scotland.  The article is entitled, "Veterans Abandoned After UK's 'Vietnam'."  Apparently, services aren't nearly up to par, and the biggest reason the article offers is that UK public sentiment is as much against the war in Iraq as it was in the U.S. against Vietnam.  Several people are quoted in the article as saying that Operation Iraqi Freedom has become the UK's Vietnam.  With little public sympathy behind the war -- as many as 2/3 are opposed to it -- there's little public embracing of the warriors who come back from the war, and they find it's too uncomfortable to talk about it with others who just don't understand. 

Additionally, services for veterans have been severely curtailed, so veterans are returning to poor care and little psychosocial support, for a war they weren't really that interested in fighting in the first place.  Read the article for a greater sense of what's going on in the UK, but let's hope that their veterans can get the care they need at this time, not later on after they've suffered even more.  One of the only great lessons for us in the U.S. after Vietnam is that we at least are coming around to understanding treating veterans better and more quickly.  It would be a shame to watch the UK suffer through what we've already lived in this regard.  Let's hope they don't have to and can fix the situation before it needlessly becomes any worse.