Healing Combat Trauma

Mind Body Medicine: Healing the Wounds of War

When I started this blog over two years ago now, I was hoping that somehow James S. Gordon, M.D., and the Center for Mind-Body Medicine which he founded in Washington, DC, would somehow get involved in the prospect of bringing mind-body medicine to the troops.  Gordon is a Harvard-trained psychiatrist, with impeccable credentials, who has a lifetime interest in expanding patient care into new areas, particularly Complementary and Alternative Medicine (CAM), and mind-body medicine in particular.  (Mind-body medicine is a shorthand way of re-combining the two "halves" of medicine perhaps unjustly sundered in an arbitrary Cartesian mind-body split.  Much of Eastern thought, rather than Western, never saw them divided at all.)  In a previous lifetime, where I interviewed luminaries in the natural medicine field, Gordon was a favorite interviewee - smart, genial and with a very forward-thinking grasp of what mind-body medicine could accomplish.  Gordon, who was featured in the Bill Moyers series on PBS, Healing and the Mind, was a frequent lecturer at the Smithsonian Institution in Washington, DC, and for years had served as the head of the White House Commission on Complementary and Alternative Medicine.  He is also a Clinical Professor in the Departments of Psychiatry and Family Medicine at Georgetown University Medical School.

But more to our purposes, when war broke out in Kosovo, he and the Center for Mind-Body Medicine (CMBM) took their methods into the region, creating a program called "Healing the Wounds of War," to help war-torn schoolchildren and their caregivers manage the trauma they had undergone, through a sustained, devastating conflict.  What I was hoping -- and I kept checking the CMBM website periodically to find out -- was that they would leapfrog off their successes with PTSD in Bosnia and Kosovo, and Israel and the Middle East, and develop something geared to PTSD in servicemembers, and the conflicts in Afghanistan and Iraq.  For years, nothing was obvious (yet), but here's some of their success with children in Kosovo.  Notice what symptoms the program helped with, how impressive the statistics are, and make the conceptual leap to how this might help with combat veterans and/or their families:

The clinical efficacy of the CMBM program with traumatized children has been repeatedly demonstrated. In a pilot study in which high school teachers in the Suhareka region of Kosovo used the CMBM model, levels of posttraumatic stress disorder in high school students were reduced from an average of 88% to 38% in only six weeks (read the research, published in Journal of Traumatic Stress, April 2004, linked here). Participants have also reported the following documented effects of CMBM trainings, including: the alleviation of their own stress and trauma; decreases in anxiety and depression; increased optimism; decreased anger; and increased capacity to help others.

You can read more about the program's specific successes, here.  Or, you can read a general overview of the program and what's involved, here.  You can also read Dr. Gordon's bio, here.

Chaplain John Morris, Minnesota National Guard

Caveat gentle reader: We have no idea if Chaplain John Morris, oft-quoted chaplain of the Minnesota National Guard, is any sort of functional expert on PTSD.  What we do know is he's a straight-talking, reasonable proponent of caring for the troops, and as such, he totally has our vote of confidence.  Here's a little biographical information about him:

John Morris, an Army Reservist, has served in Norway; Kuwait; Qatar; Iraq; Cuba; Ft. Steward, Georgia; Ft. Benning, Georgia; Ft. McCoy, Wisconsin; Ft. Bragg, North Carolina; and Ft. Irwin, California. After serving as senior pastor at St. Croix Valley United Methodist Church for eight years, he was mobilized to serve with Army Special Operations Command in January 2004. In Iraq, he visited Psychological Operations teams in 17 different camps. Chaplain Major Morris is currently a full-time chaplain with the Minnesota National Guard. He is a 1986 graduate of Minnesota's Bethel Seminary.

He's frequently quoted by NPR, the Cloquet, Minn. Pine Journal, which did a fine series of articles on Minnesota's returning National Guard veterans, and the Christian Science Monitor.  We've blogged about hm in a series of posts, linked here.  He's immensely quotable, and he's a heartsy proponent of meeting the troops head on with the type of care they need, and he seems to have that rarest of all professional qualities -- a serious clue.  I'm a huge fan...

(References to Chaplain John Morris of the Minnesota National Guard on this blog are here, here, here, and possibly here, not to mention, most recently, here.)  In his wonderful essay, linked here, you can read his thoughts on "Beyond the Yellow Ribbon: How Churches Can Help Soldiers and Their Families Readjust after Combat."  (A podcast by Chaplain Morris is linked on another blog, here.)

One Great Book: "Home to War - A History of the Vietnam Veterans Movement," by Gerald Nicosia

"The Past Does Not Equal the Future" -- queue Tony Robbins -- well, unless we refuse to learn the copious lessons of the past, in which case it very well might -- or it might make the past look positively enlightened, by comparison.  Another take on the same thing, by the perennial, inveterate quotemeister himself, Ben Franklin: "Experience keeps a dear [expensive] school, but fools will learn in no other."  I'm reading the greatest book right now, recommended by another journalist who's interested in veterans issues -- "Home to War: A History of the Vietnam Veterans Movement," by Gerald Nicosia, linked here.  It's 2 lbs., 10 oz., 689 pages, and roughly 136 cubic inches of nowhere-else-to-be-found material on the actual history of what created the Vietnam veterans' movement, which informs the veterans' rights movement of today, including the efforts to destigmatize PTSD, figure out what it was, re-include it in the DSM manual for psychiatrists (where it had been removed), etc.  Just fascinating.  All the players are there -- dozens of politically important types, including John Kerry, Ron Kovic (if you've seen "Born on the Fourth of July," you know who he is) as well as therapeutically important ones -- Shad Meshad, Ray Scurfield, Arthur Blank, M.D., Sarah Haley, etc. 

As a late-model Child of the Sixties, I had completely forgotten how much sheer effort -- blood, sweat and tears -- it took to get certain things passed that we now take for granted: better care at the VA, better provisions in the GI Bill, etc.  I had totally forgotten about the armed protests, the hunger strikes and sit-ins at the VA, etc.  It made me wonder whether leaders of the current veteran rights movements actually KNOW this history, and know how far their predecessors had to go, to secure the rights veterans rely on today -- which still need to keep pace with the times, and haven't.  The book is just plain fascinating, and b/c it's relatively neutrally written (as opposed to written with partisanship), with a steadfast focus on the facts and the key participants -- and because it's based on 600 or so interviews with the actual players, it's both extremely well done (a PBS series in book form, but with more depth!) and should keep my interest for quite a while.  So fascinating to know, or begin to hazily recall, the all-important "backstory" of where we are today.  And the insights on the genesis of understanding PTSD are well worth revisiting, all on their own.  Great book - wish I'd known about it before. As more and more veterans send me (unsolicited, I might add) their life stories, or their experiences with PTSD, I have to say -- this book really puts an awful lot together, behind the scenes, as to why they suffered in silence for so long.  Wonderful effort, and a pleasure to read.

Too bad tomorrow is already "Father's Day," but if you're lacking a gift for a veteran dad, Vietnam era or later, and can find this in stock at a local bookstore, it's a superlative collection of everything that went before, and helps us to understand the issues of the present, through the highly informing prism of the past.

PTSD Experts - How to Find a PTSD Expert, Easily

One of the recent enhancements to this blog is the creation of an ongoing directory of PTSD experts, linked here.  These are known experts in the field of post-traumatic stress disorder (PTSD), who ideally are familiar with the ravages of combat trauma, and what it takes to heal.  This directory, which is not alphabetized, should serve as a one-stop directory for biographical information about these experts, which is of benefit to reporters, journalists, those planning conferences who need to find speakers, lawyers looking for experts to testify in court cases, etc.  If someone you think deserves inclusion isn't listed yet, it may just be that we haven't gotten a chance to post their information yet, so please feel free to submit it for possible inclusion.  Otherwise, it's guaranteed to be a continual work in progress, but already more informative than anything else that's out there -- because the information is extremely hit-or-miss on the Web -- hence the creation of this directory.  (Case in point: a U.S. government-sponsored trauma specialists directory, which shall be nameless because it was so embarrassingly bad, which listed only one(!) expert, worldwide -- seriously! why even bother? -- despite having been up for years.)

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."

The Katz Email: Can We Just Call "Bullshh!it"?!

By far the most distressing revelation from the lawsuit by veterans against the VA, currently making its way through Federal court in San Francisco has to be the toxic email, disgracefully titled, "Shh!" and written by Ira Katz, M.D., the VA's top psychiatrist, about the not-exactly-light 'n humorous topic of veterans suicides.  The email essentially attempts to cover up the severity of the number of veteran suicides that are taking place by those who are undergoing treatment at the VA.  The contents of that email by now are fairly well known -- and the general reaction is to Katz's words, not surprisingly, is revulsion.  Senators Patty Murray (D-WA) and Tom Harkin (D-IA) are two legislators calling for Katz' removal.  There's been just enough stink about his ill-chosen words that Katz has been moved to make a very superficial apology for them, a la Roger Clemens.  An article in today's Seattle PI, linked here, quotes CBS News as saying Dr. Katz now calls his word choice "unfortunate."

Erm, well, can we just call "bullshit" on this?  Because, really, it's more than the choice of words people are reacting to -- they're sensing the specious and supercilious attitude behind them.  In the immortal lines from Oliver Wendell Holmes, "Even a dog knows the difference between being kicked, and being tripped over." 

The "Shh!" email brings to mind another bureaucratic bumbler of late, Michael Brown, head of FEMA during the Katrina crisis, who ostensibly fiddled while Rome burned, writing superficial emails to his colleagues preening about his choice in ties and lamely wondering if it was time for him to go home yet. "'Can I quit now?' FEMA chief wrote as Katrina raged," according to an article archived here on CNN.com.

Brown certainly seemed to be over his head (no Katrina puns intended) at FEMA; perhaps Katz, because of his psychiatry training is actually not.  However, they both have a world of learning to do in how to project empathic leadership.  There's nothing confidence-affirming about either one of their responses. Wounded warriors deserve a lot better from the top psychiatrist at the VA responsible for their care.  Those aren't just poorly-chosen words, there's an attitude of callous disregard for the patients behind them as well, that no thin veneer of apology really corrects.  Combat veterans struggling with alarmingly high and well-documented rates of PTSD and suicide need compassionate leaders with a vested interest in their care, not someone making light of the size and the severity of the problem.  In anyone but a psychiatrist, whose field after all is mental health, we might find this easier to understand or excuse.  But in a psychiatrist whose professional responsibility is the mental health of veterans?  Absolutely not.  That's a vote of no confidence, in someone who's sworn to uphold the Hippocratic oath to "first, do no harm."  The bumbling and apparent cluelessness of FEMA's Michael Brown in the face of a huge need for crisis management and control spurred calls for him to resign; perhaps outrage over Katz' email will do the same.  There's really no way to spin that into a positive.  The damage has already been done.

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Here's the content of the email Katz titled "Shh!" for those who haven't seen it.  According to the article in the Seattle PI, "Our suicide-prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities," Katz wrote in a Feb. 13 e-mail to Ev Chasen, the department's communication director. "Is this something we should [carefully] address ourselves in some sort of release before someone stumbles on it?"

VA Head Peake Talks to Veterans at Local VFW

The tiny Salisbury Post, from Salisbury, North Carolina, has an article in last Friday's paper about the current VA Secretary, James Peake, M.D., meeting with veterans at the local VFW, along with their U.S. senator, Richard Burr.  Click here for the link.  The story is entitled, 'Old soldier' vows to take care of veterans, deal with VA claims backlog," and it's an interesting story to read, mostly from the point of view of wanting to remember, for posterity, what Peake is saying his point of view is regarding veterans.  The article quotes him as saying, among other things, "The idea is to get out and really understand what's going on with the veterans, and how well we're taking care of them."  While that's a laudable sentiment, so far as it goes, it and other quotes like it make Peake sound an awful lot like he's currently on a "fact-finding mission" at the moment, talking with veterans to see how their care is going, and how they and their families feel about it.  And if that's true, it's "nice."  It's a little bit like childhood memories of school principals or maybe even superintendents walking around the lunchroom, asking elementary schoolers who basically had no real vote in the process how they liked what the cafeteria was serving. Somewhat of a pr move, even at the best of times, and if the school were in fact on fire, really not the best use of time, or conversation to be having.

In the present case, it seems that the facts of what's been going on with veterans care have been more than adequately laid out for all to see, and that the process of triaging out the worst problems and starting with fixing them could already be underway.  So I'm not really sure what to think about this.  I want to believe it's sincere, but talking with a few veterans and VA staff at a single VFW doesn't really constitute aggressively going after change.  It's fair to say most of us who've been following this topic with any regularity already have a pretty clear idea of what the issues are.  And here's the thing: there's basically NO TIME TO WASTE, while veterans are dying by their own hands, or taking forever to get in and get appointments to be seen, etc.  There's an old saw in the legal biz that "justice delayed is justice denied," and the same is true here.  The difference between being seen or treated and not can mean the difference between life and death to some veterans.

I understand and sympathize that there's a public relations aspect to any job this big, and Peake is very much a political appointee, not an elected official.  However, to the extent that we can dispense with the fireside chat and start triaging the mess we're in, so much the better.  The public relations aspect might be better left for a window of relatively little activity, in other words, when things seem reasonably fine.  If things are pretty much under control already, then great, get out there and met the vets, and get the scorecard on how things are really going.  But when the scorecard is already in the paper, and is already clear for all to see, it seems like it's more likely a form of not taking things seriously enough.  If my car is up on blocks in the yard, it's really not time to get it detailed, or fuss about how long it's been since I've washed it.  More serious issues are afoot -- with all due respect, let's get ON with it.  There is no shortage of work to do, and veterans to be served, who, with their families, are waiting.

Mental Health of Veterans' Family Members Deserves Attention, Too

Just a quick note to mention that Todd Bowers, Director of Government Affairs at the highly pro-active Iraq and Afghanistan Veterans of America ("IAVA") recently testified before the House Veterans' Affairs Subcommittee of Health about an additionally important topic: the mental health of veterans' family members.  The topic?  "Mental Health Treatment for Families: Supporting Those Who Support Our Veterans" -- that would make a great slogan.  (A few days later, the Christian Science Monitor also covered this topic, in an article entitled, "A New Push to Help Families of Veterans."  That article is linked here.)

It's no secret though perhaps it should get much more attention that combat trauma affects not only veterans but also those in their immediate families.  A veteran's suffering affects his or her family members significantly, as the burden of caregiving falls most strongly on the veteran's immediate family.  There are physical, emotional, social and financial costs to caregiving, not the least of which is strained mental health.  At least with Vietnam veterans, studies have shown that children of veterans with PTSD are at increased risk for suicide themselves. (Although it's the subject of some controversy, an Australian government study of their own Vietnam veterans concluded that children of veterans were three times as likely as the general population to commit suicide.)  It's great to see that the IAVA is making the case that more resources need to be allocated for families' mental health resources as well.  For more information on this important topic, see the IAVA blog entry linked here, or the House subcomittee's site, linked here.  For a link to the audio coverage of the hearings, click here.  For earlier blog posts on caring for the caregivers, click here; or about the family, click here.

Editor's Note: It's interesting to note that just today, the Australian government published its conclusion, that counseling services would be made available to their veterans and families.  To read more about it, download this PDF.  To learn more about the Australian Vietnam veterans health studies, click this link to a subsequent blog post.

"Stop Googling Yourself, You'll Go Blind"

You learn the most interesting thing by reading your blog stats / log of who's visiting.  Today's most pressing question: What was QTC Management, Inc., of Diamond Bar, California, doing a search for "QTC Medical Services is fraudulent" today, about THEMSELVES?!  Trying to contain bad press coverage before they even get any?  Planning something fraudulent (just kidding...) or just wondering who already thinks they are?  God only knows.  But one thing is for certain:  People spend a whole lot more time trying to control their public relations, than focusing on improving quality of services delivered.  THAT would be time better spent.

There isn't much to find, in terms of volume, of articles out there suspecting QTC of actual fraud.  But there is one main article from the LA TImes in 2006, reprinted on several veterans' watchdog-type websites, which talks about its highly cozy relationship with the VA.  The most recent former head of the VA, Anthony Principi, ran QTC, and immediately after his tenure at the VA, returned to lead it; not to mention, the current head of the VA, James Peake, M.D., also comes directly from there.  IAVA president Paul Rieckhoff was quoted as saying, it raises questions that QTC seems like the farm team for the VA.

Apparently QTC had a bad habit of bloating the bill for its services -- making it, what, the Halliburton of veterans medical care?!  And it isn't the greatest that there's such a close relationship between QTC and the VA.  But as for fraud?  Wonder what they're looking for, and why they're pre-emptively looking for it.  Maybe it's like American Express registering the domain name, IHateAmericanExpress.com (which they did).  They know someone's going to, so why not beat them to the punch.  Hmmmn...

Here's some good backstory on the topic, from VA Watchdog.org.  Click link here to read.  And in the meantime, we'll leave you with the graphic to ponder yourselves:

Editor's Note: Humorous "Googling Yourself" comic is courtesy of the JoyofTech.com, linked here.  Used with permission.

Nate Fick's Inspirational Stance on Veterans Care

Last year around this time I had the pleasure of meeting Nathaniel Fick, author of the stupendous One Bullet Away: the Making of a Marine Officer.  (Here he is at the Marine Ball at the Harvard Business School, where he is an MBA candidate, signing a few copies of his book.)  Whenever I think of combat trauma, I think of how inspirational Fick's own words on the subject were.  Writing in an article in the Boston Globe from August 28, 2005, entitled, "Coming Home...to What?" Fick wrote about the need to take veterans' psychological health seriously on their return from combat, possibly even mandating screening for combat trauma/PTSD.  Said Fick at the time:

The screenings are only one step in the long process of reintegrating combat veterans, but mandating them would correct a dangerous oversight and better serve both veterans and the communities where they live. To have value, though, the screenings must be done right.  Members of the active-duty forces are already subject to post-deployment mental evaluation, as are the National Guards of several states. These screenings often involve little more than filling out forms.

I remember slogging through my own mental health questionnaire after leaving Iraq, answering questions such as ''Did you ever feel that your life was in imminent danger?" Yes.  Or ''Check all that apply: I saw the dead bodies of a) enemy combatants; b) American forces; c) civilians; d) all of the above." D.

Answers like mine should have prompted some sort of follow-up, but none came.

Psychological screenings in a vacuum are worse than a waste of time because they give a false sense that someone has been ''cleared." The main lesson of my experience is that the recovery process takes time, and healing only happens in community. Screenings can be gateways to those communities, both formal ones such as therapy groups and counseling sessions, and the informal networks of friends, neighbors, and colleagues with whom we live.

In a war whose burden is borne almost exclusively by the tiny minority in uniform and their families, veterans' care is one place we can all make a difference."

Nate Fick's book, One Bullet Away: the Making of a Marine Officer, is well worth reading, as is the rest of his writing.  But most of all, I appreciate his inspirational stance on veterans issues -- that taking care of veterans really is the second half of the social contract, if the first half is sending them off to war on our behalf.