Healing Combat Trauma

"Healing Happens" -- Support Our Work at Healing Combat Trauma

Are you a combat veteran with PTSD, a family member, caregiver, or healthcare provider who believes -- as we do -- that "healing happens"?! Then purchase some beautiful gear at CafePress that shows the world you believe in healing.

We've got T-shirts, hoodies, coffee mugs, even a baby bib and an awesome-looking messenger bag that all share the same message of healing and hope. A portion of the proceeds from the sale goes to benefit our work. We hope you'll take a look, at our Healing Combat Trauma store on CafePress, linked here.

And thank you in advance for your support of our work.

Week-long Clinical Training Program at the National Center for PTSD

Just back from the week-long and yes, truly fabulous, "clinical training program" at the National Center for PTSD, held on the campus of the VA in Menlo Park, CA. Here's a link to the program. It could not have been better.

We learned so much -- classes ran from 8:00 a.m. to 5:00 p.m. daily, and the stack of handouts, double-sided, ran to 14 lbs. of material. One of the best parts of the program, and there were so many, was the opportunity to observe the men's inpatient residential treatment program for PTSD. That was outstanding. It was hard not to want to follow those guys' progress through the rest of the 60-90 day program. They were working hard at getting better, and it was inspiring.

There'll be more to share about the experiences in the program and what we learned as time goes by, but for right now I just wanted to mention it. It was outstanding...

Understanding Post-Traumatic Stress as a Mental "Illness" without Judgment: A Sufferer Clears Things Up

Periodically we come across something great that a PTSD sufferer has written about what it's like to live that experience, not just read about it. The following post is uniquely compelling and articulate, and it's written by Joan Esnayra, Ph.D., founder of the Psychiatric Service Dog Society. Read more about Joan's organization here. But for her wonderful letter, reprinted with permission, keep on reading below:

Dear Veterans,  

Here is what I wrote in response to one of [name redacted's] posts the other day about whether or not PTSD is a mental illness.   It comes from the heart and it is offered with respect, (if not a little tough love, too).

Dear [Name Redacted],

I know that a lot of veterans are not happy hearing PTSD referred to as a mental illness.  Perhaps this is because of some latent fears about what mental illness really is.   Mental illness is quite simply abnormal brain function in the domains of speech, cognition, behavior, and/or sensory capacities.   Not all abnormal brain function is a mental illness, but all mental illnesses are characterized by abnormal brain function.  Does this make sense?

PTSD is described extensively in the DSM-IV. This is the 'Diagnostic and Statistical Manual of Mental Disorders.'   It is the bible of Psychiatry. You don't go to a podiatrist or an audiologist for PTSD treatment.  You go to a mental health professional. This is because it is a mental illness. There is no value judgment, here. It's just a fact.

I've been diagnosed for so many years that sometimes I forget how scary it was for me when I received my first mental health diagnosis at the age of 25 (Major Depression & PTSD). Having grown up with a mother who attempted suicide with some regularity throughout my childhood years, the last thing I wanted to receive was a mental health diagnosis. Voila! There it was staring me in the face. And, despite the fact that I should have been hospitalized (indeed hospitalization was offered to me), I declined the invitation, swearing to myself that I would not become my mother!  he idea of psychiatric hospitalization was absolutely frightening to me at the time.  

Since then, I have "been there, and done that". I've seen what psychiatry and neuroscience have to offer people like me (and people like you). Did you know that Bipolar Disorder is believed by some researchers to be a dysregulation of the circadian rhythm circuitry of the brain? Where is the mental illness in that?   How can a genetic malfunction of the brain's day/night &  sleep/wake cycle cause people to suicide to the tune of 25%? To say that something is a mental illness, is not personal.  There is no value judgment in the statement. It is just the category of pathology that each of these mental disorders falls under.   It is logical and nothing else.

One of the things that veterans with PTSD have to reckon with is that they do have a mental illness. For some of you, this is a no-brainer, no big deal, like "Duh, that's pretty obvious, Joan." For others, especially the newly diagnosed, this prospect is exceedingly frightening. Allow me to proffer that the fear is not in the classification, rather, it is in our own assumptions about mental illness. When I give public presentations on PSD, sometimes people assume that I am a non-mentally ill psychologist, because I come across professionally, and because I know my subject matter, and I'm articulate. I couldn't possibly be a knife-wielding psycho, right?  I mean, isn't that what mentally ill people are really like?

Of course not!  Mentally ill people are as diverse as any other group of people. You have the high functioning, the low functioning, the assertive self-starter entrepreneurial types, and the passive, quiet, stay at home types.  The whole gamut of humanity is represented on the spectrum of mental illness. There is no "type" among those who live with mental illnesses. As a result, there is no judgment, either. 

The mental health consumer community has been pioneering PSD for 13 years.   We have an intervention that the veterans community wants and needs.  Thus, we need to be building bridges to communication so that we can benefit one another over the long term. Disparaging the characteristics of persons living with mental illness is not going to get us there. So, I'm asking you to re-think your assumptions about mental illnesses and the people who live with them.  

Someone in this group recently disparaged others' talk of suicidal ideation and self-injury. This is incredibly disrespectful to our community members.  Unless you have walked a mile in someone else's moccasins, it is inappropriate to disparage a legitimate feature of their disability. To do so is tantamount to making fun of someone who wears a colostomy bag.  "Hey Poopy Boy, You Stink!" That would be terribly rude. Don't you think?

One of the assumptions that people who are not comfortable with the concept of mental illness make is that people with mental illnesses are victims. This strikes our community as a completely bizarre attribution. What is a victim? Ostensibly, it is someone who, through no fault of their own, is harmed, used, or taken advantage by some force that is more powerful than they are. Using this definition, one might conclude that persons living with mental illnesses are indeed victims to the same extent that anyone is a victim,...of their own genetics!

But, there is another way of using the term 'victim' that disparages the sufferer. In this instance, there is implicit judgment that the person is weak, cowardly, ineffectual, and quite frankly, worthless in the eyes of society.This is the version of 'victim' that I was responding to when I read the term in your previous post. It offended me. I am not weak or cowardly or ineffectual, or worthless, and I AM mentally ill. I have no shame about saying to the world, "I live with mental illness". If I did have a problem with this, then, it would be more so a problem of self-acceptance. The fact is, I am mentally ill. Underestimate my abilities and I will prove you wrong.   Call me mentally ill, and I will agree with you.   Do you see the challenge, here, to familiar assumptions?

The veterans community needs the PSD community, and the PSD community needs the veterans community. We are like newly reunited cousins.  My side of the tracks has never gained societal acceptance because we could never hide the fact that we live with mental illnesses.  (We've been symptomatic our entire lives). Your side of the tracks has experienced societal acceptance in your role as non-mentally ill soldiers. Importantly, your side of the tracks (your peer group) has accepted you on the condition that you are not mentally ill.   

Well, guess what? Living with PTSD means that you ARE mentally ill.  So, do you go into the proverbial closet (a lot of people do), or, do you establish a separatist agenda ("we are not like those people"), or are you going to challenge society's fundamental assumptions about mental illnesses?  It is my sincere hope that you will choose the more enlightened path and look for ways to challenge societal assumptions about persons living with mental illnesses with an eye towards growing a more equitable society for all of us.

Joan

No Easy Answers: Guide for Survivors after a Loved One Commits Suicide

The Mayo Clinic has produced a short, readable, highly useful guide, available online, to how to handle a particularly painful topic: "Survivors of Suicide: After a Loved One's Suicide," which is linked here. As they write, "Bereavement after a loved one has taken his or her own life is often more complicated, intense and prolonged than it is with a death from natural causes. Although as a survivor of suicide you may never fully recover and always feel a loss, you can learn how to cope better and eventually move forward in a way that's healthy." The short, succinct guide encourages the reader to: "brace for powerful emotions after a suicide;" expect certain "physical reactions after a suicide;" as well as "emotions in the weeks after a suicide;" ways to "find support and treatment;" and "healthy coping strategies" after a suicide, finishing up with "the future after your loved one's suicide." Worthwhile guide to bookmark. 

After Combat: Looking for Health in a Handful of Pills?

From a week ago: The Savannah Morning News had an excellent article, by Pamela E. Walck, called "One soldier's struggle: Sgt. fights anger, treatment system," linked here. (There's also video, but it's not as on target as the article is.)

Sergeant John Jones, now part of the Warrior Transition Unit at Fort Stewart, Georgia, is the subject of the article, and by any standard he has a lot on his plate.

He was deployed with the 3rd Infantry Division's  2nd Brigade's 1st Battalion, 30th Infantry as a gunner, serving his second combat tour at age 29, when he was injured by an IED blast in July of 2007.  Less than six months later, doctors also discovered a brain tumor, and operated.  Since then, though the difficulties you could anticipate from those incidents alone would be enough for one person to cope with, there's been more. Symptoms of PTSD, trouble with authority both on and off the base, difficulty sleeping, the sense in Jone's own words that his personality is not what it was before, a (fortunately) failed suicide attempt, etc.  Really a painful story, of what sounds like a good man, having trouble coping with the after-effects of his injuries. The one peace in his life appears to be a rented cabin, where he goes for solace (and to fish!), yet is in danger of being taken away from him.

Walck does a great job reporting the story, and not settling for just the usual details. Through her work and Jones' own words, you're drawn into the story of what amounts to really a typically "wounded warrior." And while you find yourself pulling for Jones to survive and thrive, you can't help noticing that the "hope" held out for him is not much more than a handful of pills. Who he feels like he's lost, in his words -- echoing that of so many other combat vets with PTSD -- is "the old John," who he's now all but lost entirely. How he's going to get that guy back... is unfortunately anybody's guess. (As an additional difficulty, it's unclear whether his brain injury is making his behavioral issues worse -- it's likely that it is.) In the meantime, we can hope for peace and a healthy solution for Sgt. John Jones -- but for those who want a broader-than-usual, fully-developed "portrait" of one wounded warrior, struggling with the ravages of combat and PTSD, be sure to go here and read his story.

EFT: "Emotional Freedom Technique" for Combat Veterans

If you know anyone who's watched "The Secret," with its emphasis on "the Law of Attraction" -- heck, if you know anyone who's watched Oprah, who promoted "The Secret" extensively on her shows -- you know someone who's probably heard of EFT.

What you might not realize is there's a body of work developing that shows its effectiveness with PTSD.  And some of its biggest fans are the veterans themselves, who've tried it.

"EFT," or "Emotional Freedom Technique," is a form of what's known as "energy psychology," or "energy work."  It was developed by a Stanford engineer -- note, not a psychologist -- Gary Craig, who calls it accurately "a needle-free form of acupuncture."

Craig and EFT practitioners have done some remarkable work with PTSD veterans.  If this subject interests you, or you've looked into various forms of treatment before, and you're even slightly open-minded about trying something with a large upside and very little (or nonexistent) downside, this video in particular is worth watching.  Here's the link. 

The most moving part of the video, in my opinion, is the obvious before and after shots of the veterans themselves, going from visibly struggling, to visibly coping, in very short amounts of time. The excitement of a family member, shown later on the video, is also palpable.  A few studies have also been done on EFT and PTSD -- a book has also just been published -- with more studies to come.  The results are refreshingly impressive, though, for such a low-tech technique.  According to the video, veterans report symptoms drop 63% after treatment, according to a self-reporting scale used by the military.  Symptoms of depression and anxiety reduced by 50%, on average. Cortisol levels -- we've talked about their significance here, here and here -- drop 25% after one hour-long treatment.

Watch the video first, to orient yourself as to what EFT is and how the sample of combat veterans from various wars -- Vietnam, the Gulf War, and Iraq -- responded to it. Then, to learn more, here's an article from the Scottish press about a combat vet and his experience with it.  Here's a story about a Vietnam vet and his experience with EFT. There's a new book by Gary Craig on EFT for PTSD. If you're a veteran, there's a study you can be part of that we blogged about the other day, and that study includes several sessions of EFT. (That post is linked here.)

But if you're intrigued -- after watching the video -- and you want to know more, you probably want to find an EFT practitioner to try it out with.  There's a subset of practitioners listed on the Web, linked  here, who are interested in working with veterans, including -- gasp! -- some who already work at the VA.  If there's no one in your area, you could try this link instead, to find an EFT practitioner who may not have a special interest in veterans, and yet could introduce you to the practice.  It seems to be something low-tech, affordable, simple to learn, and an after an initial introduction, very much DIY (Do It Yourself).  Practitioners may also be willing to negotiate or lower their fees for veterans: Ask.

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Editor's note: Talking about EFT, or any other technique, should not imply or be misread as an endorsement. In any case, YMMV (your mileage may vary).

 

Veterans Sought for National Clinical Study on EFT and Combat Trauma

Veterans sought for combat stress study

Veterans from wars in Vietnam, Iraq and Afghanistan may be eligible to participate in a clinical study investigating the effectiveness of Emotional Freedom Technique (EFT) at releasing combat-related stress, trauma and memories.

Qualifying veterans will receive six free private sessions of EFT with a professionally trained coach, including follow-up assessments after 3-6 months.

Combat-related conditions include insomnia and/or nightmares, drug and/or alcohol dependencies, anger, anxiety, depression, paranoia, obsessive compulsive behavior, panic attacks, phobias, rage, grief, survivor’s guilt, feelings of isolation or jumpiness around people.

The study is organized and sponsored by the Iraq Vets Stress Project (http://www.StressProject.org), a project of Soul Medicine Institute, a nonprofit research corporation.

For more information contact Susan Maloney, an integral life coach and EFT practitioner, at (707) 888-0246 or susan@susanmaloney.com.

Learning to Bounce Back: Helpful Hints for Increasing Personal Resilience

"Resilience" or the concept of "increasing personal resilience" is something we're hearing about more and more in connection with PTSD.  For combat veterans and their families, the greater the amount of personal resilience, the more fully they'll be able to "bounce back" from trauma (hence the image of the boomerang, which quickly returns to its source.)

 

According to the dictionary, "resilience" is "The ability to recover quickly from illness, change, or misfortune; buoyancy;" and the intrinisic "property of a material that enables it to resume its original shape or position after being bent, stretched, or compressed; elasticity."

According to the National Center for PTSD, and its PowerPoint presentation on PTSD 101, presented by Fred Gusman, M.S.W. and colleagues, three keys to resilience are the "ABC's" of "awareness" (of one's limits, emotions and resources); "balance") among personal and professional activities [their presentation was to clinical caregivers, so that's explains the inclusion of that sentence]; and "connection" (to one's inner self; to others, and to something "larger" (typically spiritual).) A connection with others, in particular, "breaks the silence of unacknowledged pain; offsets isolation; and increases validation and hope."

 

The short, pithy presentation also offers these

 

Helpful Hints for Personal Resilience:

• Make connections/relationships;
• Avoid seeing crises as insurmountable problems;
• Accept that change is inevitable;
• Set goals and actively move toward them;
• Take decisive actions;
• Look at problems as triggers for personal growth;
• Don’t blow things out of proportion;
• Remember and use past coping, success, strengths. 

-- Source: APA Task Force on Resilience, 2002, quoted in National Center for PTSD’s "PTSD 101," linked here.

"Purple Mountains' Majesty and PTSD": Colorado VA Hospital Hosts Three-Part Series on PTSD

According to an article in today's Grand Junction (Colo.) Free Press, the local Veterans Affairs hospital is sponsoring a three-part series for veterans, their families, and the community on PTSD.  The series apparently started yesterday (Wednesday) and will continue on the following two Wednesdays, July 16 and July 23.  According to the article, session was led by social workers Gerry Mitchell and Austin Sorensen and "educated the group on the symptoms, perceptions and impacts of PTSD on the soldier and his or her family."  Next session will discuss "veterans’ family members coping with PTSD." (Hey, I hope they see our blog entry from yesterday on that exact subject -- "Home Sweet Home -- After Deployment, What? Support for Returning Veterans and Families," -- linked here!)  The third week's session will let veterans discuss their own experiences with PTSD. (My buddy, Kathie Costos, over at "Wounded Times," mentioned this upcoming series with great excitement the other day.  As she knows, veterans are often not that eager to seek help, but this series looks like a very positive development.)

Editor's Note: The article, by Marija B. Vader, called "PTSD attracts crowd at VA hospital," is linked here. The main website of the VA Hospital in Grand Junction, Colorado, is linked here.  (That site also includes driving directions.)  The hospital is located at 2121 North Avenue, in Grand Junction, CO 81501, and the phone number is (local) (970) 241-0731 and Toll Free:(866) 206-6415.  The sessions apparently start on Wednesdays at 5:30 p.m. in Building 6 on North Avenue.

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. 

Healing Hands: Cranio-Sacral Therapy, Veterans and PTSD

Before we leave off talking about Complementary and Alternative Medicine (CAM) therapeutic strategies for dealing with PTSD (usually, in addition to other approaches, not instead of other approaches) -- as we have been discussing lately on this blog, an index to which is linked, here -- it's important to mention one other therapeutic technique: Cranio-Sacral Therapy, developed by Dr. John Upledger (pictured at left).  You'll have to go elswhere -- like the Upledger Institute's website, linked here -- to learn more about the practice -- it would take too long to explain here, because there are several schools of thought on why it might work, and it's a fairly esoteric practice to begin with.  But...an important but...it is a bodywork therapy, akin to massage but not the same as massage, which has shown some effectiveness in improving the symptoms of PTSD.   Digging around on the Upledger Institute's site may help you learn about who practices it in your area of the country, but that is unlikely to be a completely comprehensive list.

For those who believe -- and it surely isn't everyone who does, but many do -- that the physical body "stores" trauma, craniosacral therapy attempts to "release" the stored trauma through the very light, deft touch of the craniosacral therapist.  Not everyone who's been through trauma wants to "talk about it," or "take medications for it" -- for those who are comfortable with a massage-like experience, craniosacral therapy is an opportunity to see if trauma can be cleared, lightly or substantially, using a different method.  (Rumor has it that the Navy and/or the Marine Corps, on the West Coast, is experimenting with using craniosacral therapy to treat PTSD -- more news as that develops.)

Dr. Upledger, and another West Palm Beach, FL-area craniosacral therapist, who I have known for years, and who used to practice together, worked in a novel program years ago to treat Vietnam veterans who were struggling with the effects of PTSD.  In their program were a handful of veterans and at least one medical nurse who had served during Vietnam.  The treatment program allegedly helped some, didn't help some others, and had at least one anomaly as a result: a patient who died in an unrelated car accident, soon after he reported to his family, unfortunately, how much relief he was gaining from the program.  So the results were mixed, but in general, more positive than negative.  (There was even some interest from a famous Hollywood filmmaker, who shall remain anonymous, but who's a big fan of veterans and the Vietnam experience, in filming the experience of veterans undergoing the treatments, but that created controversy for the program, and the idea was eventually dropped.)

Years later, Dr. Upledger did more work with other veterans, and at least one of them, Steve Shumelda, LMT, an ex-military guy with injuries of his own, including PTSD -- was so impressed by the treatments that he gave up whatever he was doing for a living before, and studied craniosacral therapy instead.  He has a practice in South Florida now, and has written about his experience with craniosacral therapy.  You can read more about the Upledger Institute's work with veterans and PTSD, here.

Dr. Upledger has apparently done a video that is available via his Institute on PTSD and veterans and craniosacral therapy.  You can contact their office to see about purchasing a copy.  For additional resources to read up on the topic of craniosacral therapy, veterans and PTSD, click here for a separate blog entry we did recently that consolidates a few in one place.  To read about Vietnam veteran and former Navy corpsman Steve Shumelda, LMT's experience with PTSD and craniosacral therapy, click here.

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.

Mind Body Medicine: Healing the Troops

We've talked about James S. Gordon, M.D.'s Center for Mind-Body Medicine and their successes in "Healing the Wounds of War" recently on this blog, and the wait to see if they would revamp this program to address the needs of PTSD and the troops.  Finally, at long last...The Center for Mind-Body Medicine's program for Healing the Troops, informational material linked here.

From their website:

The Center has created a program of training in mind-body medicine and on-going support for physicians and mental health professionals working with veterans returning from Iraq and Afghanistan as a first step to providing veterans with a powerful and healthy approach to dealing with the stress of war and to enhancing their resiliency.

This program will be a significant focus at our Fall 2008 Mind-Body Medicine training, for which we have received funding to bring 20 military healthcare professionals on scholarship. We are seeking additional funding for this important effort.

Also from their website:

The Center for Mind-Body Medicine has developed a trauma relief program utilizing mind-body skills including biofeedback, relaxation, guided imagery, meditation, drawing, and breathing exercises that has been used successfully around the world.

This program, which is presented in small educational groups, has the advantage of enhancing veterans’ capacity to help themselves while mobilizing social support crucial to full recovery. The Center has used this program to assist in population-wide healing efforts in war-torn and traumatized regions around the world, including Bosnia, Kosovo, Macedonia, Israel and Gaza , and in the United States with NYC firefighters post-9/11 and in post-Katrina Louisiana.

Further information about the 2008 conference is linked here. Dr. Gordon's bio is linked here.

"Give an Hour" Helps Fill Veterans Counseling Gap

Give an Hour -- the foundation that matches member psychogists and counselors with veterans and their families in need of counseling at no charge -- to fill the currently unmet gap in mental health services, has been in the news recently.  (You can learn more about Give an Hour's founder, Barbara V. Romberg, Ph.D., in her bio, linked here). It's truly fantastic to see this public-spirited act of service on the part of Give an Hour; at the same time, it's a shame that private industry, so to speak, has to jump in to fill the unmet gap of mental health care -- the need for which care is an entirely predictable "soft cost" of going to war.  Nevertheless, good stuff, and very altruistic and forward-thinking on the part of Dr. Romberg and her organization.

From a press release:

The American Psychiatric Foundation, Lilly Foundation And Give An Hour Join Forces To Provide Mental Health Care To Iraq And Afghanistan Veterans

Heeding the call of a growing public health crisis -- the unmet mental health needs of returning soldiers and their families -- Give an Hour (GAH) and the American Psychiatric Foundation (APF) announced a major expansion of a nationwide effort to help U.S. veterans returning from Iraq and Afghanistan.

GAH and APF, the philanthropic and educational arm of the American Psychiatric Association (APA), will be using a $1 million grant from the Lilly Foundation to recruit and educate volunteer mental health professionals, who will become part of a network aiming to bridge the gap in mental health services for soldiers returning from service, as well as their families. Among troops returning from Iraq and Afghanistan, approximately 40 percent of soldiers, a third of Marines, and half of the National Guard members report psychological problems, but mental health services are in short supply.

"This all-volunteer effort provides badly needed support to help our veterans, many of whom come home with mental health needs," said U.S. Representative Steve Buyer (R-Indiana), Ranking Member, House Committee on Veterans' Affairs. "I applaud the hard work of Give an Hour, the American Psychiatric Foundation, and the Lilly Foundation, which are stepping up to help those who have selflessly served."

Efforts will be made to create a large, national, volunteer network over the next three years to address postwar mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), drug abuse, anxiety and depression.

"This grant will allow us to get out the message that help is available. We want to normalize what our military personnel and their families are experiencing and support the sacrifices that they are making by providing critical mental health support at no cost," said Barbara V. Romberg, Ph.D., founder and president of GAH. "We will be educating the military community and broader public about these mental health needs in hope of helping veterans keep their lives and families intact."

GAH is recruiting mental health professionals to volunteer one hour each week for a minimum of one year to provide direct services in person, by phone or in consultation with schools and community organizations that serve the military community. Services are wide-ranging and include marital and family therapy, substance abuse counseling and treatment for PTSD. APF brings strong ties to the psychiatric community and is actively encouraging psychiatrists to join the network.

"This grant will help us reach our goal of recruiting 10 percent of the 400,000 mental health professionals in the United States by 2015 to assist in this effort," said Dr. Richard K. Harding, M.D., president of the APF. "It is an ambitious goal, but we are confident it can be achieved."

The Department of Defense (DoD) is making an unprecedented attempt to encourage personnel to seek mental health treatment, but a significant increase in demand, in some areas, has forced the rationing of services, created long waiting lists and limited individual counseling sessions. In addition, some members of military families such as parents, siblings and unmarried partners do not qualify for care through the Veterans Administration or DoD but are affected nonetheless by the mental health of the veteran.

"We're privileged to be able to give something back to our troops, but we know there's still much more to be done," said Steven Paul, M.D., executive vice president for science and technology and president of Lilly Research Laboratories. "Lilly is fully committed to assuring that the best possible medicinal treatments are available, but unfortunately, we also know that having access to the best care -- in this case mental health services -- is essential."

About Give an Hour
Give an Hour is a nonprofit 501(c)(3), founded in September 2005 by Dr. Barbara V. Romberg, a psychologist in the Washington, D.C., area. The organization's mission is to develop national networks of volunteers capable of responding to both acute and chronic conditions that arise within our society. Currently, GAH is dedicated to meeting the mental health needs of the troops and families affected by the ongoing conflicts in Iraq and Afghanistan. Give an Hour now has approximately 1,200 providers across the nation and continues to recruit volunteer mental health professionals to its network. For more information or to volunteer to become part of the effort, please visit http://www.giveanhour.org.

About The American Psychiatric Foundation
The American Psychiatric Foundation is the charitable and educational subsidiary of the American Psychiatric Association. The mission of the foundation is to advance understanding that mental illnesses are real and can be effectively treated. For more information, please visit the foundation's web site at http://www.psychfoundation.org.

About Lilly
Lilly, a leading innovation-driven corporation, is developing a growing portfolio of first-in-class and best-in-class pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers -- through medicines and information -- for some of the world's most urgent medical needs. Additional information about Lilly is available at http://www.lilly.com.

From Give an Hour's website:

Our Mission
Our mission is to develop national networks of volunteers capable of responding to both acute and chronic conditions that arise within our society. Our first target population is the U.S. troops and families who are being affected by the current military conflicts in Afghanistan and Iraq. Give an Hour is asking mental health professionals nationwide to literally give an hour of their time each week to provide free mental health services to military personnel and their families. Research will guide the development of additional services needed by the military community, and appropriate networks will be created to respond to those needs. Individuals who receive services will be given the opportunity to give an hour back in their own community.

Our Focus
Our organization is currently focusing on the psychological needs of military personnel and their families because of the significant human cost of the current conflicts. Over 1.6 million troops have been deployed in Afghanistan, Iraq, and the Persian Gulf since September 11, 2001. Nearly 550,000 of these troops have been deployed more than once. According to the U.S. Department of Defense, as of May 15, 2008, nearly 4,600 American troops have died in Iraq and Afghanistan. Roughly 32,875 U.S. troops have been injured during these conflicts.

In addition to the physical injuries sustained, countless servicemen and servicewomen have experienced psychological symptoms directly related to their deployment. According to a RAND report released in April 2008, over 18 percent of troops who have served in Iraq and Afghanistan--nearly 300,000 troops--have symptoms of post-traumatic stress or major depression. At the same time, about 19 percent of service members reported that they experienced a possible traumatic brain injury. And let us not forget: millions of Americans belong to the families of these servicemen and servicewomen. Spouses, children, parents, siblings, and unmarried partners of military personnel are all being adversely affected by the stress and strain of the current military campaign.

Our military leaders are well aware of the human cost of this campaign. Indeed, they are attempting to address the psychological needs of the troops through a variety of programs within the military culture. Unfortunately, the tremendous number of people affected makes it impossible for the military to respond adequately to the mental health needs in its greater community. For example, according to the RAND study, only 43 percent of troops reported ever being evaluated by a physician for their head injuries. Moreover, returning combat veterans suffering from depression, anxiety, and post-traumatic stress disorder (PTSD) are not routinely seeking the mental health treatment they need. RAND also reports that only 53 percent of service members with PTSD or depression sought help over the past year.

A major barrier preventing military personnel from seeking appropriate treatment is the perception of stigma associated with treatment. Many fear that seeking mental health services will jeopardize their career or standing. Others are reluctant to expose their vulnerabilities to providers who are often military personnel themselves, given the military culture’s emphasis on strength, confidence, and bravery. Servicemen and servicewomen might be more inclined to seek help if they know that the services provided are completely independent of the military. By providing services that are separate from the military establishment, we offer an essential option for men and women who might otherwise fail to seek or receive appropriate services.

We are also offering services to parents, siblings, and unmarried partners who are not entitled to receive mental health benefits through the military. Although these individuals may have access to mental health services through other means, they are less likely to seek the help they need and deserve if that help is difficult to find or costly. Our goal is to provide easy access to skilled professionals for all of the people affected by the current war. The participating mental health professionals offer a wide range of services including individual, marital, and family therapy; substance abuse counseling; treatment for post-traumatic stress disorder; and counseling for individuals with traumatic brain injuries. Whether it is a young military wife who is anxious because her four-year-old has had nightmares since her husband’s deployment or a father who is struggling to cope with his son's loss of a leg as a result of an explosion in Iraq, both will receive the assistance they need to move through their experience. The healthier the support system for the returning troops, the lower the risk of severe or prolonged dysfunction within these military families.

Our Plan
Give an Hour is reaching out to the military community in several ways. As a member of America Supports You, a Department of Defense program that provides opportunities for citizens to show their support for the U.S. Armed Forces, we are identifying individuals involved in post-deployment processing of returning troops. We are developing collaborative relationships with the commanding officers of returning troops so that these officers are aware of and comfortable with the services we provide. We are also working closely with a number of veterans service organizations to promote our services directly to the family members of troops. Furthermore, we are working with individuals affiliated with Walter Reed Army Medical Center in Bethesda, Md. We are also collaborating with the Veterans Administration to distribute information about our services through Vet Centers across the country.

Finally, we are promoting our services to the military community and the public through a media campaign that includes print, television, and radio coverage. In fact, our founder and president, Dr. Barbara Romberg, has been interviewed in national media outlets from the Washington Post to NPR's Diane Rehm Show, Ladies' Home Journal, and HD Net's World Report.

Give an Hour recruits mental health professionals in several ways. We have been endorsed by the American Psychiatric Association and the National Association of Social Workers and are seeking endorsements from other major mental health organizations. Only licensed mental health professionals are included in the network. Licenses are verified. Non-licensed pastoral providers may be included in the network as long as they meet other criteria, including membership in professional organizations. In addition to coordinating with national organizations, we also recruit mental health professionals through professional publications and Web sites.

As of May 2008 we have a redesigned Web site, expanded to include materials to guide visitors seeking services as well as reference materials to inform mental health professionals. Only mental health professionals trained and experienced to work with trauma victims will identify themselves as available to work with soldiers who have experienced combat. We are working with experts in the trauma field to prepare materials for our Web site and to find appropriate mental health professionals for recruitment.

The Eli Lilly and Company Foundation recently awarded Give an Hour, in partnership with the American Psychiatric Foundation, a major grant that will allow us to spread our message to the leaders of the mental health community in every state. 

We are recruiting volunteers from a number of organizations and institutions as well as through our Web site to assist us in the implementation of our program. Volunteers from retired military personnel to members of military families to concerned civilians throughout thte country are helping Give an Hour. Volunteers are checking licenses, distributing brochures, and coordinating community partnership opportunities for those troops and family members interested in giving back an hour to their own community.

Our Vision
Our primary focus will always be to attend to those in need by linking them to individuals in our society best equipped to respond effectively. In addition, we will develop research and educational programs to further promote the value and importance of a new kind of volunteerism. We hope to encourage an increase in shared responsibility for those citizens who are suffering. We need only look at the outpouring of aid and support following both the terrorist attacks of September 11, 2001, and Hurricane Katrina in August 2005 to see the potential we have to become a truly compassionate and united nation. And we need only look at the significant costs of the war in Iraq and the relief efforts for Katrina’s victims to see that federal and state governments are already strained beyond their means. We have not only the potential but the duty to help one another in times of need.

For more information, contact Barbara V. Romberg, Ph.D., Founder and President, Give an Hour.  Her email address is linked here.

Pick Up the Phone, Hon - That's the VA Calling!

In a seemingly odd, but -- one would hope -- nonetheless proactive move -- the Department of Veterans Affairs (VA) is now placing outgoing calls to in a nationwide campaign to inform and connect returning combat veterans with the services the VA provides.  The calls, which are being outsourced to a provider called EDS, are initiated by the VA and follow a very specific, and laudable intention,  In a PR blurb published on the Web at TCRNet, the following information was provided about the program:

The Combat Veteran Call Center is expected to make more people aware of health care and benefits eligibility for veterans of the wars in Iraq and Afghanistan. It’s the first task order awarded under the General Services Administration’s $2.5 billion USA Contact contract vehicle, according to EDS.

Calls to veterans began on May 1 and plans include reaching out to nearly 570,000 recent wartime veterans over the next six months. The campaign will initially focus on roughly 17,000 veterans who, based on their wartime injuries or illnesses, are considered candidates for care management.

The second phase will include contacting about 550,000 Operation Iraqi Freedom and Operation Enduring Freedom veterans who have not yet enrolled for VA health care services."

Additionally, "Officials at the company say EDS phone representatives will make initial calls to veterans to complete interview that will assess their needs. Representatives also will provide information about available VA health care services and benefits. Follow-up calls will also be completed to ensure that the veteran has had his or her needs met."

 

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At least one Veterans Service Officer I spoke with, while praising the existence of this program, also cautioned that its emphasis on prioritizing contact with OIF/OEF veterans over those of previous wars, could have the unintended consequence of creating friction between Vietnam veterans and Iraq and Afghanistan veterans -- groups which have been reasonably supportive of each others' existence, so far.  In fact, Vietnam veterans have been incredibly gracious about seeing that veterans of more recent conflicts get the help they feel was denied to them.  So any move that pits the two groups against each other in triaging care runs the risk of causing unnecessary friction and competition for what amounts to limited resources.  And speaking of limited resources -- although the proactive calling is in some ways a good idea (and positive PR for the frequently embattled agency) -- more and different solutions are desperately needed.  Examples include: hiring more psychotherapists, exploring treatments other than drugs and group therapy, making sure patients get seen quickly, expanding services to include outreach and education for family members, and freeing up some cash for paying private providers who are now giving their time for free, to make sure veterans get seen.  Oh, and eliminating the stigma of mental health care to career veterans, who are sometimes afraid to be seen for the impact it might have on their career advancement.  We're not even gonna mention the "shhh!!!" email here -- or the tendency to want to call PTSD by any other name including adjustment disorder -- there's enough about that in the news already.

Army Broadens View of Possible PTSD Therapies, Includes Complementary and Alternative Medicine

A Military.com article published on May 29th reports on the U.S. Army's increasing openness to non-traditional therapies to treat PTSD.  The article by Bryant Jordan is called, "East Meets West in Army Mental Therapy," and it quotes Col. Elspeth Ritchie on the Army's increasing openness to options beyond traditional counseling and medication, to include items like yoga, acupuncture, meditation, and of course, virtual reality. The headline is positive, but in truth, the Army may be taking only baby steps towards including nontraditional therapies, often known as Complementary and Alternative Medicine (CAM).

(Some "definition of terms" is in order.  "Alternative medicine" means treatment choices other than conventional medicine, to be used instead of conventional medicine; "complementary medicine" means treatment choices to be used in addition to conventional medicine -- so the term "CAM," or "Complementary AND Alternative Medicine" is meant to be inclusive of both approaches.  This ends up being an important distinction, because responsible M.D.s are often more in favor of patients adding complementary therapies in to their treatment protocol, rather than replacing a conventional treatment protocol with fully alternative therapies. "Complementary" is misspelled in the Military.com article as "complimentary," which further confuses the terminology.) 

The article states that "Therapies that are "kind of tried and true" remain at the forefront of treating Soldiers with behavioral problems, [Col.] Ritchie said. These include behavioral therapy and exposure therapy -- where patients are "exposed" by degrees to scenarios that may be at the core of the problem -- and medication."  And it further quotes Col. Ritchie as saying that although CAM therapies "are interesting, we don't have the hard data to show which therapies are useful for what population. So we're really in the research phase of this for yoga, acupuncture and some other therapies."

The Military.com article is linked here.  A previous article by Noah Shactman in Wired magazine on March 25 discussed similar material, and mentions a Department of Defense grant opportunity with a closing date of May 15, providing $4 million in funds to study therapies with possible benefits for PTSD and/or TBI, including but not limited to "music, animal-facilitated therapy, art, dance/movement, massage therapy, EMDR program evaluation, virtual reality, acupuncture, spiritual ministry, transcendental meditation, yoga and other novel approaches."  (The grant opportunity announcement is linked here.)  According to the Wired article, reading from the grant application, the Army is willing to contemplate as well the potential effectiveness of "biologically-based treatments, botanicals, and nutritional supplements for enhancing cognitive function and mood in patients with trauma spectrum disorders, including TBI and/or PTSD, depression, anxiety, and/or substance dependence/abuse," and adds, "Even proposals for wild-sounding "therapies using bioenergies such as Qi gong, Reiki, distant healing and acupuncture" would be accepted."  The Wired article is linked here.

I'm unclear whether the Army is leading the way of all the military branches in considering the potential of CAM for PTSD; but whether it is or isn't, kudos to it for being reasonably open-minded.  One of the problems that seems to keep coming up with PTSD is that no one obvious choice comes up in treating it, that works every time.  There are a variety of pharmaceutical drugs that are prescribed, but no one remedy in particular appears to be the wonder drug, or cure-all.  (You hear the frustration about this when you listen to the stories of combat veterans who are taking a handful of pills to combat PTSD, sometimes as many as 20 or 30 separate medications - a scary cocktail, indeed.)  Other approaches for PTSD, such as talk therapy, cognitive therapy, EMDR, etc., all have their place in the pantheon of treatments, and each has their adherents/proponents, but again, there doesn't seem to be a one-size-fits-all, cure-all for PTSD.  In the absence of the medicinal "silver bullet" that cures all PTSD, it's great that the Army is at least embracing the concept of possible adjunct therapies, while asking them to prove themselves clinically, as much as possible.

In the following weeks, we will report on complementary and alternative therapies that appear to have some benefit in treating PTSD; in addition to the more mainstream approaches that are already in use.  (Virtual reality is another type of treatment entirely: dependent on technology, it doesn't fit the typical rubric of CAM, nor should it.)

Making Art from War: Art Therapy as a Treatment for Combat Veterans

A recent article entitled, " Art Therapy for Combat-Related PTSD: Recommendations for Research and Practice," make the heavily-referenced case that we shouldn't overlook art therapy's potential for treating PTSD in combat veterans -- particularly because of its nonverbal nature, and its ability to integrate and express experience trapped below the level of conscious thought.  Typically, art therapy has been under-studied, or studied with victims of trauma who are children, not combat veterans -- but over time, those facts are changing.  The article, linked here, and referenced in a previous blog post linked here, is well worth reading.

They introduce their argument by saying (citations are everywhere in the original article, I'm leaving them out of this summary) that PTSD is difficult to treat in part because no single treatment has emerged as the clear leader, with effectiveness across the board.  Similarly, PTSD can be somewhat intractable to treat because any trauma severe enough to cause PTSD seems to affect the brain's underlying physiology.  Pharmaceutical drugs and talk therapy, among other treatments, are commonly-used approaches for treating PTSD, but the attractiveness of art therapy as a treatment is expressly because of its non-verbal nature.  It has the potential to allow combat veterans to process and integrate what has happened to them, without specifically requiring them to talk about it -- something many veterans are reluctant to do.

Some interesting points from the article:

 

PTSD is thought to be caused in part by the nature of traumatic memories, which are encoded in implicit as well as declarative memory systems and are likely to exist primarily as dissociated emotional, perceptual, or sensory fragments with no coherent verbal, symbolic, or temporal basis (O’Kearney & Perrott, 2006; Reisberg & Hertel, 2004).

 

Furthermore, implicit and declarative memories of an event can become disconnected due to trauma. These qualities of traumatic memory make it hard to describe traumatic experiences in words or to “integrate” them as part of one’s life story (Christianson, 1992; van der Kolk,Hostetler, Herron, & Fisler, 1994). The failure to process information symbolically (verbally or otherwise) after a trauma is thought to be a core element of PTSD (van der Kolk & Fisler, 1995). Indeed, brain imaging research has demonstrated hypoactivity in Broca’s area, which is involved in the motoric aspects of speech, and hyperactivity in the amygdala (fear, anger), hippocampus (memory), and occipital cortex (visual processing), among veterans with PTSD (Rauch & Shin, 1997).

 

By their nature, traumatic memories are difficult to express in words alone. Non-verbal expression, as is used in art therapy, can facilitate both the shift to declarative memory and the creation of a coherent narrative. The narrative can be pictorial rather than verbal. Indeed, visual imagery may be necessary for the symbolic processing involved in constructing a trauma narrative (van der Kolk & Fisler, 1995).

 

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Additionally,

 

Although art therapy has not been extensively researched, a number of small studies of art therapy for veterans with PTSD have yielded promising results. In a study designed to identify which components of a specialized inpatient PTSD program (SIPU) were most effective, Johnson and colleagues (1997) found that art therapy was the only component among 15 standard SIPU components, such as group therapy, drama therapy, community service, anger management, and journaling, that produced the greatest benefits for veterans with the most severe PTSD symptoms. (The other 14 components were most effective for those with the least severe symptoms.) They also found art therapy to be exceptional in that the veterans could tolerate war-zone content during art therapy and could not do so during other activities. The authors surmise that art therapy was more effective than other therapies because it provided pleasurable distraction in conjunction with exposure to difficult content and thus allowed traumatic material to be processed without the negative short-term side effects of verbal introspective interventions. Other studies also have found art therapy to be more effective than verbal therapy for veterans with PTSD. Morgan and Johnson (1995) assessed a drawing task for treating nightmares in combat-related PTSD and found that those who did the drawing task when they were awakened by nightmares had fewer and less intense nightmares than those who did a writing task.

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Editor's Note: To learn more about art therapy, or to find an art therapy practitioner who may have some experience with PTSD (and there could be very few who do), contact the American Art Therapy Association, Inc., 11160-C1 South Lakes Drive, Suite 813, Reston, VA 20191.  Tel.: (888) 290-0878 or
(703) 212-2238.  Their website is linked here.

 

 

 

 

 

 

"Abandon Hope, All Ye Who Enter Here..."

It sounded like potentially good news for veterans and their families at the time, but I'm wondering if it ever really happened.  Human guides were proposed to lead wounded veterans through the maze of healthcare.  On November 1, 2007, the Kaiser Daily Health Policy Report published a news item called "DOD, VA Team To Provide Care Coordinators for Servicemembers, Veterans."  These "Federal Recovery Coordinators," as they were termed, were established "to help veterans with health care and recovery." 

According to the Kaiser Daily Health Policy Report, the Department of Veterans Affairs and the Department of Defense would establish “federal recovery coordinators” responsible for helping guide wounded servicemembers and veterans through their health care and recovery.  Apparently this was an idea introduced by the Dole-Shalala Commission, although it also could be a common sensical approach conceived of by any overburdened friend or family member of an injured veteran.  The concept was that ideally these coordinators would not just aid their clients in navigating the healthcare options available to them, but also produce better coordination between the two departments, Defense and Veterans Affairs.  Strangely enough, the goal to have ten coordinators trained and ready to go by January, 2008 -- a mere two months later -- and in place at the largest veterans healthcare installations. 

It's mid-2008, and I don't know about you, but I've not heard another thing about this.  Do they exist?  Was the plan scrapped because it was too ambitious or otherwise untenable?  Are they out there, but keeping a very low profile?  Inquiring minds want to know...

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This is what the Kaiser Report said at the time:

The departments of Defense and Veterans Affairs on Wednesday signed an agreement to establish "federal recovery coordinators" who will be responsible for guiding wounded servicemembers and veterans through their medical care and recovery, the Washington Post reports. The recovery coordinator position was a key element of a presidential commission's recommendations to help improve health care services for military members and veterans returning from the wars in Iraq and Afghanistan (Vogel, Washington Post, 11/1).

The coordinators will be responsible for overseeing care coordination between the two departments' health care systems, and they will assist family members as well (AP/Contra Costa Times, 10/31). The first 10 coordinators, who will be provided by VA and trained by January 2008, will be assigned to large military health care facilities. Michael Dominguez, principal deputy undersecretary of defense for personnel and readiness, in a statement said, "This agreement will help ensure our nation's wounded warriors and their families receive the care they need and deserve at the right time, right place and by the right person across the continuum from recovery through to their reintegration into their communities" (Washington Post, 11/1).

All we want to know is, then what happened?

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Editor's note: for all the non-literature majors in the crowd, the title comes from Dante's Divine Comedy, and is supposed to be what the poet imagined was written over the gates of hell.

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.

National Women's Trauma Recovery Program ("WTRP") for Women Veterans

More than a decade ago, the Department of Veterans Affairs opened the National Women's Trauma Recovery Program (WTRP) as part of the National Center for PTSD at Menlo Park, CA. The WTRP, designed to treat women veterans with post traumatic stress disorder (PTSD), is the first residential program of its kind and is open to women across the country. Many of the women who are referred to the program were sexually assaulted during their military service and suffer what is now referred to as Military Sexual Trauma (MST). The WTRP is intensive 60-day residential program with a strong emphasis on interpersonal skills. The initial two weeks of treatment involve psychological and psychosocial assessments in order to develop comprehensive treatment plans. Women come into the program in classes, or cohorts, and work together to problem-solve, learn effective communication, and better manage their PTSD/MST symptoms.

Here's a list of key links:

• An overview of the Women's Trauma Recovery Program (WTRP), linked here.
• A statement about who's eligible to attend, linked here.
• The application itself, linked here.

The WTRP progam is headed by Darrah Westrup, Ph.D.  She has some positive, uplifting things to say about the program itself, including this quote: "our program is all about helping women reclaim their sense of worth and personal power." For more of her remarks, click here.  For more about Darrah Westrup, Ph.D., click here.

John (Super) Powers, Friend of Vets

John Powers is the singular driving force behind something truly amazing, called "the Resource Guide for Veterans," now available for download in PDF form on his exceptionally thorough website, Operation Vets, linked here.  (Be sure you have a copy of the free Adobe PDF Reader before attempting to download.  You can get that here.) 

The focus of the Veterans' Guide is on Rhode Island, the smallest state in the country, although the structure of it could be expanded to cover every state in the entire country -- let's just say, we can imagine all of them need one!  John, a recent college graduate, worked on the Guide for over a year, and the work he did is both comprehensive and totally original --to the best of our knowledge, there is no other guide in the U.S. like this.  The quality of the work that John did -- before he even began the graduate degree program in social work that he's now enrolled in -- was a true "labor of love," inspired by a veteran friend of John's from high school days, who'd gone on deployment and come back troubled.  John Powers was recently profiled by Vietnam veteran and journalist Bob Kerr in the Providence Journal Bulletin.  Read the original article here.  Wherever John goes in life, from this point forward, he's already done some of what anyone else would consider their best work, in a lifetime of effort.  In honor of the upcoming Veteran's Day, be sure to check out both John's site, and his superlative guide.  John is a true, though young, hero and authentic "FOV" -- "Friend of Veterans."

(If by chance you happen to be on Facebook, check out the group called "From Combat to Campus: Vets in School," that we recently started together, to give veterans who are in school for the first time, or back in school after deployment, some resources and ability to connect with one another.  That's the non-profit commercial interruption.  Now back to the regularly-scheduled program.)

Here's what John has to say about his site:

Operation Vets was created in July 2007. The ideas and the resource guide I created began in October 2006. After graduating from high school in June 2002, one of my childhood friends went off to the Marines as I enrolled at the University of Rhode Island. When he came home for Operation Enduring Freedom in 2005, I saw how war can drastically affect a persons life. The transition from soldier to civilian was not easy for him, nor was it easy for all of our returning soldiers.

I wanted to learn more about combat, the effects of being in war, the effects it has on the families back home and more importantly I wanted to find out how I could help and truly “Support our troops”. I began reading, writing, and researching all the resources available to soldiers and families. I realized the Department of Veterans Affairs (VA) system was being overloaded with new veterans filing claims, for physical ailments, combat stress injuries, anxiety, depression, post traumatic stress disorder, the list goes on. The process of filing claims through the VA system can be stressful and time consuming.

As I found out through talking with soldiers coming back from War, they don’t need anymore stress than they already have to deal with. I fully understood that not only are the soldiers affected, but the families are directly affected as well. They need support and help just as much as the returning soldiers do. If soldiers and families don’t get the help they need it could have devastating affects on the soldier, the family, the children, and society in general. Our country is undoubtedly in a time of War and politics rule the news stations. I am trying to take the politics out of the equation and focus on our soldiers, our veterans, and their families.

Soldiers stories need to be heard, wounds need to be healed, regular civilians need to get involved and our country needs to unite just like it did after the attacks on 9/11. I refuse to allow our returning soldiers to “slip” through the cracks as many have, since returning from Iraq or Afghanistan and even Vietnam. These soldiers served our country and it’s time we serve our soldiers.

Read other blog entries we've done about John and his commitment to veterans here and here.

Documentaries Now Available on DVD

Two fantastic documentaries about combat trauma and returning veterans are now available for purchase:

The excellent and recent New England Cable News documentary, "Hidden Wounds," is available for purchase by sending $20 to Doreen Vigue, Director of Communications, New England Cable News, 160 Wells Avenue, Newton, MA  02459-3302.  NECN plans to show this documentary again on Memorial Day, 2006.  You can learn more about local, New England-area showings of this timely documentary by clicking on this link.

The PBS/Frontline documentary, "The Soldier's Heart," is available for purchase at www.ShopPBS.org online, or by clicking this link for DVD, or this link for VHS.  Amazingly, if you've got the time and the high-speed Internet connection to make it worth your while, you can also watch the entire program online, by clicking this link.

(Both are very much worth your while.)