Healing Combat Trauma

"Not Victims, but Veterans": Max Cleland Writes an Open Letter to Other Combat Veterans

Max Cleland, decorated Vietnam war hero, triple amputee, head of the Department of Veterans Affairs under President Carter, and PTSD sufferer, who came to that knowledge in later life, decades after his military service, has written a new book, called Heart of a Patriot: How I Found the Courage to Survive Vietnam, Walter Reed and Karl Rove.

There was an interview with Cleland on NPR's Morning Edition yesterday, October 6, 2009, linked here.

But most interesting for our purposes -- since this blog is about combat veterans and PTSD -- is the "open letter" to other veterans that Cleland writes, and which is excerpted as part of the NPR piece.

"As combat veterans," he writes, "we have been through some of the most traumatic life experiences possible. War is as close to hell on earth as anything ever could be. That does make us different from our loved ones back home. War marks us all, some more deeply than others."

There's some wonderful, heart-felt expression in this letter:

"The soldier's lot is to be exposed to traumatic, life-threatening events — happenings that take us to places no bodies, minds, or souls should ever visit. It is a journey to the dark places of life — terror, fear, pain, death, wounding, loss, grief, despair, and hopelessness. We have been traumatized physically, mentally, emotionally, and spiritually. Some of us cope with exposure to hell better than others. Some are able to think of their combat experiences as but unpleasant vignettes in a long and wonderful life. It is not to those veterans I am speaking. I love them, but I am not afraid for them.

I am speaking to the rest of my brothers and sisters, those who find themselves trapped in the misery of memories as I was for so long. For them, I am afraid.To those veterans I say, you are not alone.

Many of us have been overwhelmed by war. Many of us have been unable to cope on our own with what has happened to us or with what we have done. Many of us have been left hopeless, lost, and confused about ourselves and our lives in ways we never thought possible.

That does not make us victims. It makes us veterans."

The rest of the open letter is equally wonderful, and well worth reading. In it, Cleland talks about his own personal highs and lows, what he understands about PTSD and his own case, and what has helped him get through. It's clear the concern and caring he feels for other combat vets. The letter is linked here.

Teddy Roosevelt on Veterans - Give 'Em a Square Deal, Afterwards, for Serving

A quotable quote from the 26th president of the United States, who served as a legendary Rough Rider during the Spanish-American War, and also as an Assistant Secretary of the Navy:

"A man who is good enough to shed his blood for his country is good enough to be given a square deal afterwards. More than that no man is entitled to, and less than that no man shall have."

How to Follow Legislative Progress on Bills That Concern Veterans, PTSD and Other Issues

"Founding Father" Thomas Jefferson was a firm believer in "open" or "transparent"  government -- and the principle of getting information into the hands of those democratically governed.  As a nod to his considerable contributions, the Library of Congress named their website for following legislation in progress after him -- the "Thomas" site.  It's a veritable "one-stop shopping" Web site for following progress on proposed legislation of concern to veterans and their families -- bills that are currently, or soon to be before the House of Representatives or the Senate.  The Thomas site, linked here, is a free service of the Library of Congress -- in other words, our tax dollars at work.  Go there and punch in any keywords of particular interest to you, such as "veterans" and "PTSD," and it will return a list of the bills that have been introduced to Congress and/or are being voted on, which include those specific terms.  Then you will be able to follow the progress of those bills more closely.

Fortunately, organizations such as the IAVA, VoteVets and others, also are in the habit of letting their members know when something they consider important is getting close to a vote, so that members can take the initiative to call their senators and representatives.  The recent successful passage of the new GI Bill was testament to those organizations' ability to get the word out from their constituents that passage was vitally important.  However, organizations will typically focus only on the bigger proposed bills, or ones with the greatest possible impact to their membership.  It behooves ordinary citizens -- you, me, us -- to become more aware in general of what proposed legislation is in the pipeline, so to speak, before it's voted on.  Then, in case we care to get more involved, or convey our point of view on it to our elected representatives.  Following a bill's progress, from proposal through passage or veto, at a site like the comprehensive Thomas site, is one way to do that.

Another way, that takes advantage of contemporary concepts like RSS feeds, is offered by OpenCongress.org, linked here.  A joint project of the Sunlight Foundation and the Participatory Politics Foundation, OpenCongress is a free, open-source, non-profit, and non-partisan web resource with a mission to help make Congress more transparent and to encourage civic engagement. As they say on their web site:

OpenCongress brings together official government information with news and blog coverage to give you the real story behind what's happening in Congress.

For most people, finding out what's really happening in Congress is a daunting and time-consuming task. The legislative process is frequently arcane and closed-off from the public, resulting in frustration with Congress and apathy about politics.

Small groups of political insiders and lobbyists know what's really going on in Congress, but this important information rarely makes its way into the light. The official website of the library of Congress, Thomas, publishes the full text of bills, but we can do much more to inform ourselves and make our government accessible. Now, with OpenCongress, everyone can be an insider.

What I liked, in particular, about their site is the alphabetical index to issues.  Under "V," you can find those issues with "veteran" in the name -- including veteran's benefits, disability compensation, education, employment, hospitals, loans, medical care, organizations, pensions and rehabilitation.  If you want to search for bills relating to post-traumatic stress disorder, or PTSD, that also has its own category, and is linked here.  You can even subscribe to that category via RSS feed, so you can track that issue, and always kept apprised of what's going on in that area, with a minimum of effort -- because it comes to you, instead of your having to go out and find it (great!).  (For the link to veterans, click here.  For subsets of veteran issues, such as the ones named above, you have to search within "V" because they're listed alphabetically, starting with "veteran" as a prefix.)

If you're as big a fan of Facebook as I am, you'll note that OpenCongress.org has both a group, linked here, and a special application for Facebook users, linked here, to track bills on their profiles. (Yay.)

Editor's note: Thanks to subject matter expert, GuvBoy, for turning me on to the Thomas site.  (And if he ever learns to embrace Facebook, let's hope I returned the favor by turning him on to OpenCongress.org.)

Congressman Filner on Health Care for Veterans

Closing remarks of Congressman Bob Filner (D-CA), Chairman of the House Committee on Veterans Affairs, on the momentous passage of the GI Bill.  While the rest of Congressman Filner's remarks addressed education, he also commented on veterans ongoing health care needs and concerns, here:

"Last year, Congress made the largest increase in veterans’ health care funding in American history, when we increased VA funding by 30 percent, successfully adding $12 billion more than the President’s request and $39 billion more over five years. The new GI Bill is an even larger fiscal commitment to our nation’s veterans - providing a quality educational benefit for those to whom we owe so much.

While we have made much progress, new challenges continue to mount. Tens of thousands of service members are being discharged from the military without adequate diagnosis or treatment for post-traumatic stress disorder (PTSD) and traumatic brain injury. Refusing to face this challenge, leaders at the VA have attempted to manipulate suicide data to portray a lesser problem. In addition, the claims backlog for VA benefits now totals well over 600,000. The VA also failed to protect our veterans when they became more involved with research than providing treatment - When Chantix, an anti-smoking drug, was linked to suicidal thoughts and aggressive and erratic behavior, the VA failed to immediately eliminate their testing of veterans, placing them under increased risk.

It is obvious that our work has just begun, and I will continue to fight to hold the VA accountable for their actions and provide the very best care to our nation’s veterans. I will work to transition the VA from Veterans Adversary to Veterans Advocate!"

-- Congressman Bob Filner, Representative for California’s 51st Congressional District, and Chairman of the House Committee on Veterans Affairs, linked here.

Editor's note: Regarding Chantix, we did a post the other day, linked here, which talks about how to learn more about the medications being prescribed for PTSD, and how to learn about possible interactions with other drugs, such as Chantix.

Needless Trauma: What Vietnam Vets Still Don't Know about Their Service Could Hurt Them

Saw this recent press release from a California congressman, who himself is a decorated Vietnam vet, and wondered about the pain that comes from NOT knowing the full extent of what you've been exposed to, as you were serving your country.  For the particulars, keep on reading:

– Today (June 12), Congressman Mike Thompson (D-CA) took another step toward helping veterans who were unknowingly tested with chemical and biological weapons in the 1960s and 70s.

The House Subcommittee on Disability Assistance and Memorial Affairs held a hearing on a Thompson-authored bill that would give these veterans health benefits and compensation for illnesses resulting from “Project 112” weapons tests. Thompson hopes this hearing will ultimately push his bill toward consideration by the House.

Project 112, which included ship-based Project SHAD, was conducted between 1963 and 1973 by the Department of Defense (DoD) and other federal agencies. The DoD now admits that during these projects, unknowing military personnel were involved a number of chemical weapon tests such as VX nerve gas and Sarin nerve gas and were exposed to biological weapons such as E. Coli, Tularemia (Rabbit Fever) and Q fever.

“First the government denied the tests existed. Then they said the tests happened but were harmless. Now they admit dangerous substances were used on our military personnel, yet they still refuse to give them care for their illnesses,” said Thompson. “We can’t change the past, but we can begin to right this wrong by giving these men the proper healthcare and compensation they earned.”

HR 5954, introduced by Thompson and Congressman Denny Rehberg (R-MT) in May, provides veterans of Project 112 a “Presumption of Service Connection.” This means the Department of Veterans Affairs (VA) presumes the relationship between service and a health condition, making the veterans involved eligible for medical benefits and/or compensation for their conditions. For example, veterans exposed to Agent Orange during the Vietnam War are already given a “Presumption of Service Connection.”

“I understand security classifications and the sensitivity of our operation,” said Jack B. Alderson, a retired Lt. Commander from the U.S. Navy Reserves and resident of Thompson’s district. “However, these were not volunteers but service personnel ordered to do a dangerous job and they did it, and did it well, now their nation needs to take care of them.”

In 1964, Alderson was the officer in charge of five U.S. Army light tug boats that were used to test chemical and biological weapons. The tug boats acted as sampling stations and targets for disseminated weapon clouds.

After the DoD admitted to Thompson that the tests did exist and included harmful agents, they released more than 6,000 names of military personnel used in the tests. However, the GAO reported in February that the DoD had halted their efforts to disclose additional names and many veterans remain unaware that they were even involved. The Thompson-Rehberg legislation would require the DoD to hand over all the names to the VA, which must then notify the veterans.

The Thompson-Rehberg legislation has been endorsed by the Vietnam Veterans of America, Veterans of Foreign Wars, American Legion, Disabled American Veterans and Paralyzed Veterans of America.

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CONTACT: Anne Warden at (202) 225-3311, (703) 338-4480 and anne.warden@mail.house.gov.

For a link to Congressman Thompson's office, click here.

WA Legislator Shows Concern for Vets, PTSD

Washington state, which counts a large number of deployed servicemembers, veterans, and their families among the state's population, has shown some real leadership in veterans' issues, particularly with Senator Patty Murray (D-WA) -- a tireless and vocal veterans' advocate, who is a member of the Senate's committee on veterans affairs.  Now representative Jim McDermott (D-WA), apparently the only psychiatrist serving in Congress (hmmm, that would explain a lot!), according to a news article in yesterday's Seattle Post-Intelligencer, has also done something good for veterans.  He sponsored a veterans' forum to "honor, help and heal our soldiers," according to the PI, and basically provided an opportunity for local, Washington state veterans to vent about their difficulties with getting appropriate care.  Not sure if anything more constructive than venting was really the purpose of the meeting, but hey, even that sometimes really helps -- for people like veterans who may not feel that anyone is really listening to how difficult a struggle they're in, coming back from deployment and being faced with a number of serious obstacles to getting the help they need.  The article is linked here.

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?"

Senators Harkin and Feingold Introduce Veterans Suicide Tracking Bill

Senators Tom Harkin (D-IA) and Russ Feingold (D-WI) on April 23rd introduced a bill requiring the Department of Veterans Affairs ("VA") to track veteran suicides.  The "epidemic" of veterans' suicides has been in the news recently, both because of the Federal court case being waged in San Francisco this week and next by veterans rights groups against the VA, and because of the recent CBS News investigation into the same.  It turns out the CBS report's high numbers were accurate; and documents produced during the trial implicate the VA's chief psychiatrist, Ira Katz, M.D., Ph.D., in attempting to suppress the true figures.  Various groups have called on Katz to resign.  The proposed legislation, entitled "The Veterans Suicide Study Act" would require the VA to report to Congress how many veterans committed suicide since 1997; and the VA would continue to issue reports annually.  For more information about the bill's introduction, click here.

New Hampshire's Carol Shea-Porter Has Veterans Issues on Her Mind -- in Congress

The Boston Globe has a profile today of freshman Representative Carol Shea-Porter, the first woman to represent New Hampshire on Capitol Hill.  Shea-Porter, a former social worker, is a member of the House Armed Services Committee, and makes veterans issues a priority.  The Globe profile says that highlights of Shea-Porter's first term include "the adoption of a bill guaranteeing that those who leave the military because of injuries sustained in the line of duty do not have to repay part of their enlistment bonuses. Shea-Porter, who managed floor debate on the bill, has made the health needs of veterans and troops a priority, in part based on her experience as a former military spouse.  "I understand we may differ on policy," she said of members of Congress, "but we have an obligation to honor our commitments to these troops."  (Porter counts 67,000 veterans in her district alone in New Hampshire.)

Such a simple concept -- that we the people, via our government, honor the commitment to support the troops.  I'd like to see every politician and especially every elected official make this a priority.  But since the Globe mentioned Shea-Porter's work in this regard, I figured I'd mention it on the blog.  Forget the yellow ribbons -- actually support the troops by giving them the benefits they need and have earned.  And don't let anything stand in the way until that happens.

For a link to more resources for New Hampshire veterans, via Shea-Porter's Congressional website, click here.  To educate yourself more thoroughly on who votes what on veterans issues, click this link to the relevant section of Project Vote Smart.

On the Campaign Trail: Obama Says Veterans "Have Earned Their Benefits"

The Associated Press has a story tonight about an emotional exchange between Democratic presidential candidate Barack Obama (D-IL) and a retired Air Force veteran, Andrew Hampton, who met on the campaign trail earlier today in Iowa.

Hampton told the presidential candidate that he feared today's returning combat veterans were coming back with serious injuries and often not getting the care they deserve, because of the whims of a mercurial Congress that plays "hollow politics" with their benefits.  In an emotional moment, the older veteran got weepy when he told Obama, "We can't desert them" (veterans).  Great point, Obama conceded -- veterans have clearly "already earned" their benefits.  He promised the teary-eyed older veteran that if he were elected president, veterans healthcare would be a priority.  He would "take care of veterans as a way of encouraging future generations to enter the military, as well as provide mental health screening and adopt a "zero tolerance" policy for homeless veterans.  "We have to fund all the services that have been promised to our veterans," Obama said. "We can't play politics with it."

While in truth there's no good reason to believe any candidate's promises as anything more than just good intentions and p.r. before the election -- the more important test is what happens afterward -- still and all, it's nice to see more attention focused on veterans issues, including healthcare -- and once again it's good to see older veterans from the Vietnam era taking care of younger veterans -- making sure that they get the care and the benefits they deserve.