Healing Combat Trauma

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

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

 

 

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

To whom it may concern,

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

 

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

 

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

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

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

 

Educate yourself on and things to do:  

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

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

• get a copy of court case file

• get a copy of VA file and military file

• jump in your lawyers pocket

• try to find a pro bono lawyer

• individual rights, Miranda and if they were violated

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

• psychology of PTSD

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

• constitutional law

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

• find a support group

• contact your senator, congressperson

• contact your local VFW, AMVETS, or veterans associations

 

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

 

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

  

Thank you for listening and God bless,

 

Scott Lee

 

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

Murder, They Wrote: Statistics on Recent Combat Veterans and Homicides

The Spring/Summer 2008 issue of the American Psychological Associations' Section VII newsletter contains an interesting article on the "postdeployment homicide" statistics of combat veterans, that basically follows up on the study published in the New York Times in January of 2008, which we blogged about, here, while expanding on it and doing additional research.  The findings are quite worth reading.

(The study's authors are Kyle Burchett, David Ferreira and Glenn Sullivan, all from the Virginia Military Institute.)

They write:

A relationship between criminal behavior and Posttraumatic Stress Disorder in combat veterans has been hypothesized almost since the inclusion of PTSD in DSM-III (e.g. Wilson & Zigelbaum, 1983). Some researchers (e.g. Chemtob, Novaco, Hamada, Gross, & Smith, 1997) have posited that combat veterans may be more prone to entering a cognitive, behavioral, and physiological “survival mode” when confronted with threats in civilian environments, and may be more likely to respond to perceived threats with overwhelming aggression. Multiple studies, beginning with the National Vietnam Veterans Readjustment Study (NVVRS; Kulka et al., 1990), have shown dramatically higher rates of violence among combat veterans with PTSD compared to combat veterans without PTSD. Beckham and colleagues (Beckham, Feldman, Kirby, Hertzberg, & Moore, 1997), for example, found rates of 22 violent acts in the past year for help-seeking combat veterans with PTSD, versus 0.2 violent acts for combat veterans without PTSD. One implication of the extant research is that combat exposure per se does not appear to increase violence risk, although the severity and quality of an individual’s combat experiences (e.g. participation in atrocities) may effect postdeployment violent behavior insofar as these factors mediate he development of PTSD.

In January 2008 the New York Times published a list of 121 U.S. veterans who had been charged with homicide after returning from deployments in Iraq or Afghanistan (Sontag & Alvarez, 2008). This list, and the series of articles that followed it, provoked strong reactions from some veterans’ advocates. Many expressed concern that the nation’s most recent veterans were being portrayed as “ticking time bombs” who pose a risk to civilian society. The authors of the present article examined the 121 homicide cases presented in the Times’ study from a clinical perspective, with the intent of clarifying the association between combat exposure and postdeployment violence in the dataset.

In addition to the information on each case available on the Times’ website, we gathered corroborative data from independent media outlets -- most commonly online versions of newspapers serving the localities where the crimes had occurred. In more than 80% of the cases, we gathered significantly more information about the perpetrator than was available in the original Times article. In fewer than 10% of the cases, we were unable to find any additional information about the case and relied solely on the account provided by the Times.

All but one of the 121 offenders were male (99.2%). The majority of the offenders (53.7%) were between 18 and 24 years old, and 85% were under age 30. Of the cases in which race/ethnicity was known, Caucasians represented the majority (54.4%), followed by Hispanics (23.5%) and African-Americans (22.1%). The most represented service branches were Army (62.8%) and Marine Corps (30.6%). Over 90% of the charged offenders had served in Iraq, and 10.7% had served in Afghanistan; two of the 121 has served in both countries. Eleven offenders (9.1%) had deployed overseas twice during the current hostilities and five (4.1%) had deployed three times.

The homicide victims included strangers (35.2%), friends/acquaintances (23.0%), spouses/girlfriends (18.8%), children (8.3%), and Other/Unknown (14.7%). As in the general population, handguns were the most frequently employed murder weapon. The most common criminal charge was first-degree (i.e. willful and premeditated) murder (55.7%). At the time of this study (April 2008), nearly 30% of the cases were still pending (i.e. th veterans had been charged but not convicted). Seven of the veterans on the Times’ list (5.8%) had been acquitted of the homicide charges against them. None of the veterans received a Not Guilty by Reason of Insanity acquittal, although considerations related to combat-exposure and self-defense appear to have influenced prosecutors in at least one case (e.g. Matthew Sepi). More than one-fifth of the cases (20.5%) involved vehicular manslaughter or homicide. All but one of these vehicular cases were primarily substance-related – the prototypical homicide victim in these cases was the passenger in a vehicle driven by an intoxicated veteran.

We reviewed the compiled case material for evidence of combat exposure. In the vast majority of cases (92%), some evidence of combat exposure was provided in media accounts of the criminal proceedings. In 40% of the cases, combat exposure appeared certain: news reports included details regarding combat decorations, injuries sustained by the accused in battle, or testimony by commanding officers or multiple fellow unit members regarding IEDs, mortar attacks, clearing buildings, etc. In an additional 52% of the cases, combat exposure appeared probable: friends or family members of the accused veteran referred to combat exposure, the veteran’s unit was known to have engaged in combat during the veteran’s deployment, the area in which the veteran operated (e.g. Fallujah) was known for intense combat, etc.

We also evaluated the case files for evidence of psychiatric symptoms. Due to the nature of our data, we could not achieve anything resembling a formal diagnosis, but we reliably detected significant psychiatric symptoms related to PTSD, Antisocial Personality Disorder, Substance Abuse, or psychosis in 114 of the 121 cases (94.2%). Only four (3.5%) of the veterans demonstrated psychotic symptoms.

Significant symptoms related to PTSD were reported in 85 of the 121 cases we examined (70.2%). Family members, friends, judges, defense attorneys (and even prosecutors) referred to veterans’ nightmares, insomnia, intrusive thoughts, survivor guilt, hyperarousal, hypervigiliance, intense anger, depressed mood, and suicidal ideation. In general, we searched for evidence that the veteran had returned from combat somehow “changed” or disturbed. Approximately 34% of the veterans in this sample demonstrated PTSD symptoms only, an additional 19% exhibited PTSD and comorbid Substance Abuse, and almost 17% appeared to display symptoms of both PTSD and Antisocial Personality Disorder.

We identified 39 cases that appeared to involve significant symptoms associated with Antisocial Perrsonality Disorder (ASPD; 32.2%). Evidence for ASPD included committing violence for material gain (e.g. killing a spouse for the insurance money), killing during the commission of a felony (e.g. shooting a gas station attendant during the course of a robbery), evidence of substantial criminal activity prior to the instant offense, callous disregard for others, lack of remorse, etc. In general, we searched for evidence of pre-deployment antisocial behavior or instrumental (versus expressive) aggression. Almost 17% of the veterans in this sample (n=19) demonstrated ASPD symptoms only, an equal number exhibited comorbid ASPD and PTSD, and one displayed comorbid ASPD and Substance Abuse.

Finally, each judge rated the strength of the association between the violent act reported in each case and the combat experiences of the accused veteran. We used a seven-point scale in which “1” indicated no relationship and “7” indicated the strongest possible linkage (i.e. the crime would not have been committed “but for” the combat exposure). The mean rating for the entire sample was 5.2 (standard deviation = 1.9). Over 50% of the sample was rated “6” or higher and less than 5% received ratings of “0.” This approach requires further validation but a similar procedure may prove useful in assessing public attitudes toward hypothetical criminal cases in which combat-related PTSD is presented as a mitigating factor.

The prevalence of PTSD symptoms in this sample of combat veterans charged with homicide (70.2%) is much greater than has been found in other samples of returning veterans. This finding appears to be consistent with prior research that suggests that PTSD mediates the frequency and severity of violent behavior among combat veterans. However, it is also extremely important to note that a substantial minority of veterans in this sample (n=20; 16.5%) exhibited no symptoms of PTSD and appeared rather to demonstrate behaviors associated with habitual criminality. Criminal cases involving recent veterans, like those of Vietnam veterans before them, are likely to be marked by either legitimate claims of diminished culpability or cynical attempts to malinger the effects of trauma.

Social support is a strong protective factor against PTSD. To date, the over 1.4 million American soldiers that have been deployed to Iraq or Afghanistan have received generally positive reactions to their homecoming.

Unfortunately, this public support is not guaranteed and might be negatively affected by misinterpretation of news reports regarding violent combat veterans. Should public support for veterans deteriorate for any reason, an already immense public health problem could become even less manageable. It would be terrible for the public to conclude erroneously that returning veterans are inherently dangerous. This is why the Veterans of Foreign Wars and other veterans’ advocacy groups have taken pains to point out that the murders in the Times’ dataset yield an estimated 8.6/100,000 homicide rate in the veteran population, which they contrast to the 29.3/100,000 rate among American men aged 18 to 24.

References

Beckham, J.C., Feldman, M.E., Kirby, A.C., Hertzberg, M.A., & Moore, S.D. (1997). Interpersonal violence and its correlates in Vietnam veterans with chronic Posttraumatic Stress Disorder. Journal of Clinical Psychology , 53(8), 859-869.

Chemtob, C.M., Novaco, R.W., Hamada, R.S., Gross, D.M., & Smith, G. (1997). Cognitive-behavioral treatment for severe anger in post-traumatic stress disorder. Journal of Consulting and Clinical Psychology, 62, 827-832.

Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., et al. (1990). Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.

Sontag, D., & Alvarez, L. (2008). Across America, deadly echoes of foreign battles. Retrieved January 15, 2008, from http://www.nytimes.com/2008/01/13/us/13vets.html

Wilson, J.P., & Zigelbaum, S.D. (1983). The Vietnam veteran on trial: The relation of Post-Traumatic Stresss Disorder to criminal behavior. Behavioral Sciences and the Law, 1(3), 69-83.

Editor's note: Thanks to psychology graduate student, Melanie Goodman, for pointing out this article!

Combat Trauma into PTSD: "We're Going to Be Paying for This for a Long Time..."

Christian Science Monitor reporter Jill Carroll -- you may remember her from her own capture ordeal in Iraq -- has an excellent story in today's paper, featuring many of the names covered heavily on this blog, among them, SSgt. Travis Twiggs, and Norfolk, Mass. District Attorney William Keating.  The article is called, "When the War Comes Back Home," and it's subtitled, "When veterans of Iraq and Afghanistan bring their [war] troubles home, police and judges are often the first to deal with them."  How they deal with them becomes the gist of Carroll's story, and it's well worth reading -- and linked here.

(We'll update this blog post as we have opportunity, but wanted to get the information out there.  Carroll's article is full of good information and tightly written --  so to rehash her main points or the things you'd want to know about would take as long as having you just read the original.  Not to mention, it's good practice to do that.  So please just go read the original.  The quote in the post title is from the article, as civic officials contemplate how long the problems of PTSD from combat trauma are going to remain with us.)

Don't forget we've also written, on this blog, about the similarities between police and veterans in how they develop PTSD from repeated exposure to trauma.  While police departments across the country, and the judiciary, are contemplating ways to manage the increased incidence of crime that can be traced to returning veterans (even if it's not much, it may still need greater awareness of PTSD and special challenges to veterans to handle) -- one thing both sides might want to remember is how they're probably more alike than different.

And I'm still loving this old headline from the New York Times, decades ago, about a far different war. Any old excuse to use it is just amusing to me.  I guess people were afraid that the "crime wave" they had on their hands was due to veterans, and the New York Times had to reassure them that it wasn't.  Argh.  

NYC's Urban Justice Center Offers Returning Veterans Legal Aid and Advocacy

The Veterans and Servicemembers Project of New York City's Urban Justice Center, linked here, offers, in their own words, "legal services and advocacy to a population often abandoned by the very system of government they defend in battle. Drawn increasingly from the poorest and most vulnerable communities in the country, past and present military personnel contend with poorly regulated recruiting tactics, unsafe working conditions, and an antiquated and overloaded disability benefits process. Often unaware of their rights and wary of challenging authority, they face especially daunting barriers to necessary assistance."

Furthermore, "At an individual level, the Veterans and Servicemembers Project provides legal training and representation on matters ranging from veterans disability claims to service discharge applications. The project also pursues systemic reform through litigation and advocacy in such areas as recruiting irregularities, workplace harassment, and inefficiency and abuse in the benefits application process. With the active collaboration of existing service organizations, it aims to provide comprehensive education and support for a