Healing Combat Trauma

PTSD: (That's Some) Pretty Terrible Sh*t (to Have to) Deal (With), Don't You Think?

Editor's Note: We commemorate the otherwise momentous, historic signing of the GI bill into law today with this little snippet of what life was like for someone who served recently.  For everyone who doesn't "get" what sacrifice is, and that those who've served have earned their accolades and rewards, here's a grunt's-eye view of the experience of combat trauma, and how that relates to PTSD and various other topics in the news.  It's doubtful that any one of us would like to have changed places with him, at such a young age.  Herewith, his story, emphasis mine:

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I'm no Vietnam vet, but a vet of Operation Iraqi Freedom. I turned 18 while in boot camp because I graduated high school at 17. I was discharged early for having "personality disorder" after I went to Iraq.

I was in the Marines, and my MOS was a ground communications electronics technician. A couple months after graduating my training for the job and going to my first unit, I was "volunteered" to join and train with another unit that was leaving soon. The new task I was given was "Mortuary Affairs".

This group was put together with a couple dozen other Marines from other sections. Our job was to go to locations where troops had been killed and not able to be retrieved by the group they were out with due to the fact they were under too much danger or whatever the case. I had no clue the effects this would have on me. It was a horrible experience.

It was not like going and picking up a corpse and that's it. For one, you were in a hot zone, where people were just killed, not just by gunfire.

Here are some brief descriptions of the missions I was a part of...
 

The first one wasn't too bad; the body was actually brought to us at the camp we were at.

 

It was a young male Marine. He was supposedly in a Hummer going somewhere and might not have been wearing his helmet. He had a silver dollar sized hole in the side of his head.

When we get the bodies back the camp we have to take off all materials on the body, and go through and bag each individual body part. It was more of a surreal experience really, I did not know how I was supposed to feel.

Once our troops invaded Fallujah was when things started to get worse. On another of the missions, a truck carrying fuel was crossing a bridge and was shot with an RPG. The truck went off the bridge and fell, the fire burning most of everything.

 

When we went out it was usually just a dozen of us with maybe 2 Hummers of security if we were lucky. For anyone who doesn't know, most the Hummers used were old and poorly maintained/equipped... almost no armor. So we get there and head down to the bottom where the truck fell and we had to pull out burnt bodies from inside of the cabin.

 

It sounds bad, but burnt bodies are almost like burnt food... so perhaps it wasn't as bad as the rest. It did not help our appetite when we had to eat in the same building we processed the bodies in. Our shop was just a medium-sized bunker, no walls or anything so yes we basically ate next to the bodies. It is obvious why some of us didn't eat the meat.

 

The worst mission I went on was when an army tank was traveling down a road and was blown up from a roadside explosive. The bomb was so powerful: you could not identify ANY part of the tank except for the tracks. It had been tossed a couple hundred feet in different directions.

 

It took us I think, about 15 hours to do this mission. There was gunfire when we first arrived but nothing more. I think we picked up a couple thousand pieces of flesh that day. Going through each one individually. They would range from small penny-sized pieces to legs, torsos, heads, feet, testicles, arms, etc.

 

There were a few more missions but we get the idea by now I'm sure. I guess it started to become noticeable that I wasn't doing well. I was taking whole boxes of NyQuil tablets and drinking bottles of medicine to get anything I could out of it at night. I smoked probably a pack of cigarettes a day, which is a lot for me because I have never really smoked more than a couple cigs a day if at all.

 

My officer had me go speak to the chaplain and from there a navy doctor who was a great person to have over there. He pulled strings and had me med-evac'd out of there a few weeks later.

 

In the meantime I had been moved out of my job until I was able to leave. I was harassed for leaving: superiors thought I was just faking to get out.

 

I had become highly depressed and my roommates noticed me screaming sometimes in my sleep.

 

From Iraq I spent a few days at an army hospital in Germany, talking to various doctors and such... going through the process.

 

I was being given pills for depression and for insomnia. Then I made it back to the US and once at my base I was seen by a psychologist. They actually gave me the option to get of the military, so I did.

 

I had been told the process takes several months to year until you finally leave. In the meantime I started drinking daily, and stopped taking the pills they gave me because they seemed to numb my mind and I could not stand it because I have always had such a wonderful and creative mind. It made me feel like a zombie, I could not even create artwork which was my biggest hobby.

 

A month down the road I started having nightmares, very detailed and morbid. A few times I would wake up with tears. I began having suicidal thoughts and crying at least a few times a day. Thank God my best friend was stationed not so far, he saved my life I think.

 

It was hard for me to wake up because of the medicine I had been taking, that’s another reason I stopped it, I was always drained. The first week I was back I never even reported back to my old unit, I didn't know what I was doing.

 

A week later they send somebody to come get me. There, I was harassed and treated like a piece of s%#t some more by my master sergeant. They had me sit in inventory room all day while I struggled to stay awake. I luckily had a very kind staff sergeant in charge of me at the time. He would let me sleep and go home early.

 

I admit I was very lucky in getting out, because it only took me about 2 months until I was officially a civilian again. I was going back home. I stayed with my older sister and her boyfriend at first, because I was not too fond of going back to my parents. My depression got worse and I started to drift further from sanity and comfort; people noticed I was a different person.

 

At this point I started smoking marijuana occasionally. Which was really the only time I felt anything, happy, able to think, speak, talk to people, feel normal.

 

Eventually I moved back with my parents and that's when things got worse for me. I had some additional problems I know was facing, I needed a job, and had people on my back constantly. I had no access to marijuana during this time.

 

My insomnia got to its peak to where I could not sleep AT ALL at night. I also began having more suicidal thoughts, nightmares got worse and I had them ANY time I could sleep which was usually from 7:00 AM to 12:00 PM, began having auditory and visual hallucinations everyday, and constant anxiety.

 

I knew I had PTSD and that the military used "personality disorder" so that they would not take the rap for it.

 

I finally couldn't take the insomnia anymore and was prescribed Ambien, which actually works extremely well and helped get my body back on schedule, only thing is I had to take it for 3 months and then no more because they said it was addictive.

 

So it became difficult without it. I did a long process of seeing doctors and filling out paperwork for the VA and was finally officially a disabled vet due to chronic Post Traumatic Stress Disorder, normally referred to as PTSD.

 

I started to be able to get a hold of marijuana again and when I had it things were more stable. My temper was not out of hand and I could sleep comfortably having less nightmares. At this point I had gone a year or more straight of having nightmares every night.

 

It has been three years now and I am much better. Time has healed me a little and I smoke marijuana as often as I can. I don't have hallucinations anymore, or rarely any nightmares. I do however still have bad anxiety, temper, and depression problems when I'm not high.

 

Another thing I forgot to mention is that PTSD has basically ruined my memory. Since I first showed symptoms until now, my memory does not work nearly as well as it should.

 

I still have major problems concentrating and working sometimes too. It makes interviews and other social activities near impossible for me, as I cannot speak or express myself as I used to. I get very nervous and my mind blanks out sometimes. I cannot say if marijuana will help all my problems, but I can say marijuana helps me feel alive.

 

Being high is the only time I feel good and happy, deep down. I can be around loved ones or any social crowd without tweaking out from anxiety, I can think and operate much more smoothly, I don't have a short temper, and it makes me want to live.

 

The past couple months have been rough on me and I have been going to the VA hospital here to try and get help. The first 4 times I went, they did the same exact thing which was to ask a series of questions, ask me if I want pills and send me home. I kept telling them I did not want pills because I have seen what they have done to people I know and what they have done to me.

 

All I wanted was someone to talk to.

 

After the fourth time of going in there feeling like I wanted to die, they finally got someone for me to talk to. We have just met once so far, but I think it will be good for me.

 

In the meantime I have not been able to smoke recently because I am trying to find another job, which is not going too well and I only have a couple weeks before my current job ends.

 

I have had a few interviews but blow them miserably because it’s getting harder and harder for me to go through the whole thing without my nerves choking me to death. It’s only been a week or two since I smoked last and my temper and depression are already busting through the door. I worry too easily and stress out to the extreme.

 

Take what you will from this story, but I know for a fact marijuana has saved my life numerous times.

 

-- One young former Marine's story, in his own words. Used with permission.

Editor's note: "Mortuary Affairs" was also the detail highly-decorated Marine ("Marine of the Year") Daniel Cotnoir worked in Iraq, before a combination of circumstances, including PTSD, triggered an event in his hometown of Lawrence, Massachusetts -- which got him arrested, and barely escaped conviction.  We have blogged about Daniel Cotnoir's case many times on this blog, going back several years, when it was current.  It's safe to opine, that even within the trauma of war, some things are harder to endure than others.  Our guess would be, mortuary affairs really qualifies for extreme hardship and exposure to things that make PTSD an occupational hazard.

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

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

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

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

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

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

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

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

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

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

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

 

PTSD Drugs: Better Living through Chemistry, or Purely Popping Pills for PTSD's Psychological Ills?

There was a story in the news recently about four young combat veterans in West Virginia, all seemingly in decent physical condition beforehand, who nevertheless all died in their sleep recently.  Besides combat PTSD, one thing the vets all had in common was the cocktail of drugs they were taking: Paxil, Klonopin and Seroquel.  (The Charleston, West Virginia Gazette-Mail reported this story on May 24, 2008 - it's linked here.)  An investigation is pending, but the story obviously raises the question: what are vets with PTSD being prescribed, and is it really working, or what's best?  (Continue reading, and you'll learn more about those specific medications as well.)

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Where to go for information about PTSD medications?  Here are a few, carefully-chosen selections, and their pros and cons - as appropriate:

Jonathan Shay, M.D., Ph.D., well-known VA psychiatrist and outstanding veterans advocate, has written before about medications used to treat combat PTSD, and his impressions of them.  He wrote the material for a lay audience, in the version that's kicking around on the Web, in several different locations, and although it has been quoted by many as gospel, it's more than 12 years old by now (first published in 1995), and that's much too much time that's elapsed to consider that information really current. (The Dr. Shay list, "About Medications for Combat PTSD,"  is linked here.)  So that information is interesting for background -- and particularly for Dr. Shay's explanation of how things work and/or what makes a good PTSD medication, and what doesn't -- it out of date and should not be considered current. 

There's another list on the Web -- a table, really -- that's much more current (2006), and it lists the drug names, brand names, and how the drugs are thought to work with PTSD.  That list is linked here.  It may be a little difficult to read if you're coming to the topic cold, but perhaps not.

Some other suggestions:

If you have access to a public library or academic library, you can check out the PDR -- the Physician's Desk Reference -- and read up on a drug's profile, side effects, warnings, etc.  But since you're already on the Web, we can assume, reading this -- try going to PDRHealth.com, linked here-- and read up on the prescription drugs prescribed for PTSD.  Of the three drugs mentioned earlier, Paxil is linked here; Klonopin is linked here; and Seroquel is linked here.  You can also do a straight search for any OTHER drug used in PTSD treatment, or one with possible interactions with a drug used for PTSD, at the same site, by searching within prescription drugs by name (e.g., Zoloft, Chantix, etc.), at the general search interface, linked here.

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But the information in the PDR, whether on the Web or in the desk reference, is going to dry and technical, though worth reading -- pretty much exactly like the fine print that's packaged with the medications themselves. What you're probably going to want to know more about is what in software is called "the user experience" -- how other patients like you have experienced the medications.  For that you will need to turn to some other sources.

For what amount to "user reviews," try PsychCentral, or Revolution Health, both of which have increasingly robust user communities who will comment on their own experiences of the medications.  (Of course, not all their users taking medications for PTSD have PTSD from combat trauma, so be aware that their cases may be substantially different.)  Combined with the technical information about the drug's effects, side-effects and warnings (see links, above), it might be helpful in creating a broader picture of what the user experience is like:

Dr. John Grohol's PsychCentral website:  Paxil (Paroxetene) is linked here; Klonopin (Clonazapam) is linked here; and Seroquel (Quetiapine fumarate) is linked here. A general search through the medication library is linked here.

AOL Founder Steve Case's Revolution Health:  Users in the "User Community" provide "Community Ratings" on various medications.  The items on Paxil, Klonopin, and Seroquel are linked here (click on any of those hyperlinks to take you to the community ratings), or, use a more generic search here, and look for the tab beneath that says "Community Ratings." (We will be blogging more about Revolution Health shortly.)

Don't forget books as well.  Mark Goulston, M.D.'s Post-Traumatic Stress Disorder for Dummies (2007), linked here, is very recent, and contains a whole chapter entitled, "The Role of Medication in Treating PTSD".

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You'll also want to learn as much as you can -- though this is primarily your healthcare provider's reponsibility, yet it's in your best interests to care about this as well -- about possible interactions, if you're taking a number of medications; as well as thinking through carefully whether the risks involved are ones you want to agree to, such as the potential that a medication -- bizarrely enough, prescribed for PTSD or depression -- may actually increase risk of suicide. (An example of news coverage about this is linked, here.)  Strange, and perhaps unavoidable, but true.

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Use caution whenever evaluating information about medications, especially as a non-professional, but at the same time, don't "just" believe what a healthcare provider tells you: be sure to check it out for yourself or your family member, at reputable sites like the ones mentioned above.  Your health is in your hands, so while you want and should actively solicit the expert advice of healthcare providers familiar with PTSD -- and don't settle for less :-), at the same time, YOU are the one who's going to be bearing the brunt of anything that goes wrong, so be sure to do your own due diligence and figure out what the possible side-effects, interactions, and unpleasant experiences might be for you, before you commit to a course of treatment.  You and your healthcare provider can be partners -- that's the new model -- not just "master" and "servant," or "priest" and "parishioner."  Take an active, informed role in your own healthcare, particularly where medications are concerned. 

Dr. Ecstasy Will See You Now

An article in yesterday's Sunday Times (London, UK) talks about the drug, Ecstasy, as having therapeutic potential for treating severe, unremitting PTSD.  The article, which is titled "Ecstasy is the Key to Treating PTSD," by Amy Turner, is linked here.  The drug in question is more properly known as MDMA, or 3,4-methylenedioxy-N-methylamphetamine, pictured here.

The article says that MDMA's potential therapeutically wasn't noticed until 1976, "when the American chemist Alexander Shulgin tried it on himself. He noted that its effect, “an easily controlled altered state of consciousness with emotional and sensual overtones”, could be ideal for psychotherapy, as it induced a state of openness and trust without hallucination or paranoia. It quickly became known as a wonder drug, and began to be used widely in couples therapy and for treating anxiety disorders. None of these tests was “empirical” in the scientific sense – no placebos, no follow-up testing – but anecdotally the results were almost entirely positive."

The therapeutic potential for treating PTSD is apparently to be found, according to the article, "in the trust it establishes."  One researcher familiar with the drug, quoted in the article, states:

“Many people with PTSD have a great deal of trouble trusting anybody, especially if they’ve been betrayed by someone who abused their trust, like a parent or a caregiver,” he says. “MDMA has this effect of lowering fear and defenses. It also allows more compassion for oneself and for others. People can revisit the trauma, feel the original feelings but not be retraumatized, not feel overwhelmed or have to numb out to cope with it.”

This is obviously good news for PTSD sufferers.  The study is still in its early phases, and the reality is, that if PTSD is able to be treated with one or just a few doses of MDMA, versus potentially years of psychotherapy and/or lengthy courses of pharmaceutical antidepressants, etc., this news is likely to be welcomed more warmly by patients eager to get well than by healthcare providers who previously expected to be providing maintenance doses of psychotherapy and/or pharmaceutical care for years to come.

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The formal study analyzing MDMA's therapeutic effects on PSTD is being conduced by Michael and Annie Mithoefer, under the auspices of MAPS, the Multidisciplinary Association for Psychedelic Studies, linked here.  While this might sound like a highly "hippy dippy" research project, the reality is, the other day I called a research group at the University of Arizona's Department of Psychiatry, and listened to a recorded message about a trial of psilocybin and OCD.  (See article, linked here.)  Mainstream medicine is apparently, if only slightly, open to studying the therapeutic uses of controlled substances.  In the meantime it's important to note that the street drug, Ecstasy, which may or may not be based on MDMA, depending on the purity, is not a substitute for taking part in a clinical trial like the Mithoefers', and there is always considerable risk in attempting to self-medicate any serious health condition, especially with illicit drugs.  Read the Sunday Times article, linked here -- it's quite informative.  And keep track of this ongoing research, which looks promising for some sufferers.

Editor's Note: In a feeble attempt at true-to-life humor, this was the license plate I saw recently on a very nice, late model Acura, parked in the driveway at a state veteran's home.  Perhaps it was just a visiting DJ.