Healing Combat Trauma

Instructions for Making Your Own Fatigues Clothesline Shirt

If you're intrigued -- as many veterans who've suffered Military Sexual Trauma (MST) are -- with Regina Vasquez' great project, "Fatigues Clothesline," which we wrote about, here -- and you're considering making your own shirt to send to the collection, here are Vasquez' instructions on how to do it: 

 My uniform...

I will use my uniform blouse as an example of what to use for the Fatigues Clothesline. You can use any uniform blouse as long as it is military-related.

Vasquez says, "This is the most important part of the project. Our veterans need to do this because a simple T-shirt won't do." Using a uniform shirt makes a much bigger impact -- "a huge statement that this (military sexual trauma) is not right, and creates a whole new level of awareness. No longer a battle of the branches but more of a sense of, "let's help each other heal."

Step 1

Start with a uniform blouse. If you want to use a dress blouse do so; you can use whatever uniform blouse you want. Make sure your name is not on the blouse you decided to use. I will take mine off when I am finished. Remember, we do not want to use any names on our uniform blouse. Our goal is to voice in a discreet manner what had happened to us while serving at the same time educate others. This is a strong tool if we use this wisely. This cause does not merit discrimination against sex, gender, or the branch of service you served. It affects everyone.

Step 2 

Turn your uniform blouse inside out. The reasons why I ask you to turn your uniform blouse inside out: We as Soldiers, Sailors, Airmen, and Marines at one point took pride or are still taking pride in serving our Country. We do so by wearing our uniform, by turning it inside out we are allowing others into our world by reading what affects us today. I cannot stress what a great opportunity it is to voice it in a discreet way by allowing others to read your story.

Step 3 

Write, draw, do whatever you want in order to tell people what happened to you.  

Reminder...

(Vasquez' advice):

It is taking me some time to finish, but I am doing it. Writing my story on a uniform blouse is so much different than on a regular white T-shirt. Just the texture and color alone gives me memories of what happened. Remember when you start, prepare yourself to stop when you start to feel like you can't take it anymore. Take some time out, listen to your favorite music, go for a walk, or simply talk to a friend. When you are finished calming down and you feel ready, start again. The rewards of finally being heard feels amazing. I am here with you 110% spiritually. If you are not able to finish, it is OK. I don't blame you. I blame the person who did this to you. You are not the one at fault. You are a remarkable individual and sometimes it takes more time to talk. It took me 12 years to reach this place I am at. You are not alone.

Editor's note: Send your completed shirt to Vasquez at the following address. The project is open to both male and female veterans.

Fatigues Clothesline

c/o Regina Vasquez

P.O. Box 194

San Marcos, TX 78667-0194

The Fatigues Clothesline Project: One Former Marine Making a Difference on Military Sexual Trauma

In true Margaret Mead spirit -- "“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has" -- meet Regina Vasquez.

Vasquez is a remarkable wife, mother of five(!), college student, and former Marine, with a great project underway that deserves widespread support. (The project is for both men and women veterans.) She writes:

"I am a Marine disabled vet who experienced Military Sexual Trauma along with gender discrimination.

One day while getting ready for college I had an epiphany and now I know what I need to do. For the longest time, for about 12 years I lived with the vision in my head of the two men raping me. About a year ago I got tired of it and decided to get help. I went through group counseling along with individual counseling only to find out that yes I needed to talk to someone and now I'm ready to make it public so I am able to help those who suffered like me move past it all.

I participated in a Clothesline Project for sexual trauma survivors. For this clothesline project we got to write or make art on our T-shirts by telling our story. When we were done we all got to hang it in front our town's courthouse on a clothesline, hence The Clothesline Project's name. 

I didn't mean to take a lot of attention away from the other gals because I felt they need the validation as well but my T-shirt gained so much attention. While standing behind them acting like an observer I heard complete strangers say "I can't believe this kind of things happen in our military" and such. 

This is where my epiphany came from: Why not bring the public in by making a "Fatigues" Clothesline Project for all the women and men who did serve and are still serving our great Nation? It will be discreet, meaning no names, but still be able to have some validation and justice for our souls. I named it "Fatigues" because one fellow veteran pointed out, it is what we were wearing while going through it all and after suffering for so long we feel fatigued. 

What I'm asking from you is to take time and I know how painful it is but well worth it in the end   because for some of us, we were denied our justice due to circumstances. For some of us we may not want to tell people what happened to us. This is a good tool in helping with the process. You will be able to tell your story and no one will know who it came from and still gain the satisfaction of knowing your story is being told and heard. I want you to do this for me, please take a uniform shirt and turn it inside out. Reason for turning it inside out, it's because even though we were raped, harassed, any kind of abuse whether it be verbal abuse or physical we still take pride in serving our nation but what we go through is what we cover up with that pride for our Nation by wearing the uniform. Freedom isn’t free, this is another way of telling the public what we endured for their freedom.

So I’m asking again, no names, your story on a uniform shirt turned inside out about what you experienced while serving our country’s freedom and in return earn validation, justice for your soul and a chance to be heard. 

My goal is to hang all the uniform shirts up in a year or a year and a half in front of our Nation’s White House so that everyone will see what we go through by serving for their freedom. I want to hang them up on a national holiday, Veteran’s Day, by next year or if not, the following year. 

This is a safe way of being heard for all of us. No command getting involved, no anyone but our freedom of speech through our uniform shirts. By doing this it will allow civilians a chance to better understand us and to educate them on the matter. 

Please send your completed shirts to:

Fatigues Clothesline
c/o Regina Vasquez
P.O. Box 194
San Marcos, TX 78667-0194

Says Vasquez, about the shirts: "I will take them, protect them, will not share who they came from and guard them with my heart till it’s time to hang them."

Editor's note: Please share this post (article) with anyone you know who may have experienced military sexual trauma. Not everyone will want to participate in the project, but many will. The outpouring of support from other veterans for this project has been impressive indeed. Said another MST survivor, "(MST) is painful, powerful and more common than people realize. Thank you for being our voice."

Instructions on making the shirts will follow in another blog post, but for more information, see this graphic, which clearly shows the applicability to men and women veterans.  

From the Canadian Side of the Street: A Military Author's Take on Veterans Suffering from War and PTSD

One of the many blessings of the new media -- social media like Facebook -- are the interesting, talented people one meets within that. One such person is Bonnie Toews, a Canadian former journalist and novelist with a longtime background in writing about the military. I forwarded her an article from the Montreal Gazette last week about social workers quitting because of burnout in Canada, meaning that fewer will be available to serve returning veterans with PTSD, and this is what she wrote on her website in response:

Outrageous failure of government assistance to returning Afghanistan vets

"It is wonderful that we celebrate the lives and courage of fallen soldiers when they are repatriated to CFB Trenton and paraded down the Highway of Heroes, but the question that is never answered: who looks out for the returning vets? Especially those whose minds, bodies and spirits have been shattered on a continual rotation of tours through the past eight years.

It is disgusting and absolutely unacceptable to hear that Canada's Veterans Affairs is cutting back on social workers because WWI and WWII vets are dying off. 

Excuse me, but Canada has a whole new generation of vets who have served in Afghanistan for eight years. By next year it will be nine years. The war in Afghanistan has lasted longer than either world war in the 20th Century and soldiers have been repeatedly rotated through three and four tours because our forces aren't large enough to handle a deployment this long and this demanding. These vets and their families need help to mend their lives back together. 

Kevin Dougherty in Montreal's newspaper, The Gazette, writes that soldiers suffering from Post Traumatic Stress Disorder can wait up to four months before seeing a social worker, a necessary step to integrate them back into society and return them to the labor market. 

Why? Because federal social workers each have a caseload of 40 clients to their provincial counterparts, who carry a caseload of 20 clients each. There are not enough social workers to contend with the need, and under such strained resources, these caregivers burn out, depleting veterans' social services even further. 

People forget that soldiers returning home are not the only victims of the wars they've fought. So are their loved ones, families and friends. They need as much social assistance as the soldiers themselves. Those coming home are forever changed. They have experienced things the rest of us can't imagine. They carry this psychological burden for the rest of their lives. 

In 1994, in Rwanda, I was briefly introduced to that world of theirs. I was one of the few North American journalists covering the massive humanitarian effort following the genocide against the Tutsis and moderate Hutus in Rwanda. One peacekeeper after another told me what they saw, incomprehensible mass slaughter with no human respect whatsoever and they were forced to observe because the UN didn't give them the mandate or size of force to quell the madness. Soldiers trained to fight and defend forced to stand down. Can you imagine the helpless rage they experienced? Yet, when I came home, I faced the same apathy from friends, co-workers and the public as they did. My husband proudly explained that I had been in Rwanda and time and time again I was asked, "Did you go there on holiday?" 

People didn't even know what was going on, and were indifferent when I chose to explain. I, like so many soldiers, learned not to talk about it because no one really cared to listen. 

This time the public must get behind their vets and demand the social services they deserve and need. This is the most important tribute we can give our returning vets for the sacrifices they've made on behalf of our country."

 -- Bonnie Toews. A longtime journalist reporting for logistics and private security magazines and now a novelist, speaks out for the victims of genocide and war, from the peacekeepers and coalition forces trying to save suppressed peoples to the children and innocent civilians caught in the crossfire of opposing powers, ideologies and cultures. Current writing "Trilogy in Treason." Member of Military Writers Society of America, American Authors Association and ACFW. Her website is linked here.

Editor's note: Find us on Facebook, here; follow us on Twitter @HealingPTSD.

Busting Out of the Bunker at Last...Made to Be Social Beings, We Die in Isolation

Following up on the "Bunker" post of the other day, about the protective isolation of the bunker for the combat vet with PTSD, it seemed high time to write "the rest of the story," about what the subject of "Eyewitness to Combat" sees now about the bunker mentality, and how and whether it's possible ever to overcome it. (So here's a picture of his bunker in Vietnam, to illustrate it.)

What follows are direct remarks from the vet, from a few weeks ago, about this exact topic. I'll add a few words where I have to, to keep the flow going, but the thoughts and the wording are his:

On the problem of the bunker:

"We are made to be social beings. We die in isolation. And that’s why when we withdraw into a hole, we are withdrawing into a grave -– just one that isn’t covered up yet.

With me I wanted to get out and I wanted to be with people. I wanted to enjoy my surroundings. I wanted to go to parties. I really did. I wanted to do that. But I had this deep ingrained fear that if I was around too many people, too long I would talk too much, say too much, and they would figure out who I really was, and not like me. And every place I went, it seemed that I was always pissing somebody off. Making somebody angry at me, and that rejection was more than I could handle. So it was easier for me to decide that I just hate everybody, and don’t want anybody around me but animals. And crawl back in my bunker, and hide. But then I would die there. Because what I really wanted to do was go back and be with people who cared about me, somebody who would love and accept me and who I could have fun with. Every time that something would draw me out of the bunker, I would do something stupid, have my PTSD moment, and have everyone around me direct me back to my hole.

We are supposed to be social; we are supposed to belong. For those of us who are Marines, we belong to one another, we belong to the Corps, we belong to the men who came before us, and the men who will come after us. We belong to something bigger than ourselves, and that’s what makes us Marines for life. This is not unique to the Marine Corps however; for we all have an innate, ingrained need to belong to something bigger than ourselves; to something that accepts our faults, that builds upon our good deeds, good qualities, that involves people. Be it religion, be it Indian culture, be it motorcycle clubs, be it national associations. We all have a need to belong. The problem arises in our isolation creating a void that is filled with the wrong associations/influences. For we WILL belong to something, good or bad; harmful or helpful. Churches prey on that need to belong. (We've both had bad experiences with churches, so we give the secret fist-bump to each other at this point.)  

Now, all veterans belong to one another. Their bond is in their service, that transcends the specific branches and time.

People go back in the bunker to heal, to hide from being hurt; or to hide from hurting others. They stay there and depression sets in; and they cannot get out by themselves. Someone has to physically go in and bring them out, just like (my guy friend, a Navy seal) did with me; just like you did with me.

He encouraged me; he listened to me; he understood me; he had been where I was. He said, "I don’t know how to help you; I love you; I care for you. But I know if you don’t want to do something, you wouldn’t do it. So what I want to do is share a dream with you that I’ve had since I got out of the Navy. Reasonable or not. But I need your help to do this. And when you feel like you can come out, call me. And he left a stack of papers about a foot high. I spent a week staring at them, and it interrupted my depression! And he'd put one of the most interesting articles on the very top. He had made me a part of what he was doing. I just wanted to be and do something that people wouldn’t hate me for; wouldn’t criticize me for. Because the aftereffect of ‘Nam was so bad, because we gave so much; and received so little. And we had done MORE than we could do over there. I just wanted to do something where people didn’t hate me."

(That Navy Seal friend is someone he'd previously helped himself; stood up for him so he wouldn't go to prison for his third arrest.) "I’m the one who walked in there and walked him out of his depression. Blood brothers, combat vets. He was a friend."

I mention the name of another friend of his, who he served with in Vietnam, who was injured on his same kill day/alive day, and who used to call him up to see if they could go be mercenaries in South America together. It all sounded like an elaborate, not so cleverly-disguised death wish. Very Butch Cassidy and the Sundance Kid. When I first knew him, there was a real pull to that. Now, further down the healing path, not so much. I ask him about that guy. A lot more reasonable now, he reflects, though he knows the allure, "That’s not the way to go; it’s not the way to make you happy. It’s just another way to get yourself killed. Problem is, sometimes it works; sometimes it doesn’t."

How much time has he spent in his bunker over the years?

"Years. Probably spent 20% of my life in a bunker, hiding, wanting to die, not having the nerve to shoot myself; hoping that the diseases and the meds would finally do me in.

I just didn’t know how to be happy. There was no joy in my life. There’s no reason to live. My family used to ask me, 'How can you look at what you’ve done, and tell me that you have no purpose in life? You don’t understand.' Problem was, I didn’t understand. I did not know why I didn’t have the capacity to have joy, to love anyone or to have fun. I just know I’d tried religion, I’d tried everything the VA could throw at me, in-house therapy, group therapy, self-help, medication, I tried working myself to death, I tried getting rich, I tried doing stupid things to harm myself (go back into combat situations), where maybe if I revisited it; I tried going to The Wall; and something would just not allow to want to live, or be happy, or enjoy being in my life. I couldn’t look around and see the flowers, let alone smell them. All the roses in my life were wilted; not because they were, but because of my vision of them was wilted."

My self-esteem, my sense of self-worth, my self-pity, and sense of total uselessness overwhelmed everything else. No matter how hard I tried, everything I touched was going to turn to shit. I heard it from my dad, and then I began to believe it was a generational curse. A curse is only a curse if you decide it’s going to be a curse. I understand the Universe. I understand me and the necessity of believing in yourself and believing in others. Politically the world may seem like a shitty place; but it’s always seemed like a shitty place. World’s always been a bad place, and it’s always been full of good people, and bad ones. And we have the right to choose the ones that we’re with. And we have the right to choose whether we’re going to be happy or sad, or doing something that’s worthwhile or not. Money is essential but money’s not the end. Money is only the means to an end, and yet we lose that perspective.

I’m no longer willing to let other people and their misery dictate whether I’m happy or sad. It’s up to them to walk through that door. Sick and tired of being sick and tired, that they’d rather die than continue on. Then they’ll walk through that door and want help and accept it. As long as they have one ability to resist, they will."

We talk about two guys we know, combat vets from different eras -- Gulf War and Vietnam. Neither one seems to really "get" where they need to go with this recovery stuff. When they're doing well, they're broadcasting their healing to the world; when they're down, they're completely off the grid, hospitalized for suicidal ideation and attempts. My mind reels from this. I wish when they were doing better they'd put more time into actually finding a way out; not just broadcasting it, so their lows wouldn't have to be so low, since their highs seem...unnaturally, or at least unsustainably high. It reminds me of a friend who says, about people who complain but do not attempt to solve, "It must not be bad enough for them yet." 

He weighs in: "They haven’t lost ALL their resistance. One of two things happen when people reach that level: they either commit suicide, or they get help. What makes the difference? A friend. A friend who can walk in under that and take them by the hand and walk them out. Just like in combat, if you get wounded, you can’t walk yourself out. Someone to grab you by the nape of your neck and drag your ass out of there. You can’t do it by yourself."

He continues: "If vets who have been healed don’t go and get vets who haven’t, then no one else will. In this situation the Marine Corps phrase of “we take care of our own” is literal; if we don’t, no one else will: not the vet’s family, not his relatives; no one. Only a vet can walk out a vet."

But yet, I helped you...and I'm not a vet. But you came looking for the help, too. He replies, "But you were a friend, a sincere, concerned friend. A friend like that, another vet; not the government...."

Editor's note: The photo above is of the "Eyewitness to Combat" Marine with two of his buddies, very Three Musketeer-y, circa 1966 or 1967.

Provider Burnout among Combat Stress Healthcare Practitioners

It's been interesting to follow the Tweets from the conference at Mass. General Hospital this Friday and Saturday, on the "Complexities and Challenges of PTSD and TBI." It sounds like it was a great conference. One of the items that stood out to me was the statistics being shared about provider burnout. Check these out:

"Not enough social workers, therapists, etc. to help all the people who need help."

"146,000 mental health providers in U.S. Medical Command (MEDCOM),...a huge centralized training that's re-assessed annually for improvements...now (with) significant training resources in place to help providers manage stress." 

Studies that MEDCOM has done indicate that provider "burnout" is approximately "35% among deployed psychiatrists," "20% in deployed psychologists," "15% in deployed social workers," and "26% in non-deployed." (Source: LTC Graeme C. Bicknell, PhD, LISW, LTC, MS, Deputy Chief, Behavioral Health Division US Medical Command.)

We've written about "Caring for the Caregivers" frequently on this website, most recently here, in a post entitled, "Too Long a Sacrifice Can Make a Stone of the Heart:The Tao of Self-Care." Acknowledging provider burnout is another aspect OF "caring for the caregivers." The takeaway? Combat stress injures troops AND mental health providers; servicemembers and practitioners alike need stronger support. 

(There's a great article by Charles Figley on the topic, "The Art and Science of Caring for Others without Forgetting Self-Care, linked here, suggested by one of the readers on the Facebook site for this website, which is linked here.)

Editor's note: You can follow the PTSD Conference, now over, on Twitter, @PTSDConference; and you can follow this website on Twitter @HealingPTSD.

Victimology -- The Temptation to Stay Stuck

Every behavior has a potential payoff, or we wouldn't engage in them. This is particularly applicable to people who have suffered for years, not months, with their situation, and where the groove has most definitely become a rut.The subject of "Eyewitness to Combat" talks about how being a "f*cked-up Vietnam vet" was a mask he could wear at times -- not that those times were always under his control -- in order to get other people to back off or keep their distance. Carolyn Myss, author of the New Age classic, "Why People Don't Heal and How They Can," talks about how attached people can get to their "wounds" -- to the point that they introduce them almost immediately into conversations with strangers, or overly bond with their friends and companions over them, with the ultimate experience being that it becomes very difficult for them to move on. "Love me, love my wounds" seems to be an unspoken demand of those too attached to their victim-hood.

This isn't to say that everyone who suffers becomes a victim -- nothing of the sort. Or that everyone who flaunts their wounds, so to speak, is doing so intentionally. But for any of us who have suffered, it's important to examine the unconscious temptations behind victim-hood, lest we accidentally fall into the quicksand and get stuck. 

Bev Smallwood, Ph.D., has a book called, "This Wasn't Supposed to Happen to Me: 10 Make-or-Break Choices When Life Steals Your Dreams and Rocks Your World." She talks about how different survivors of the same experience (say, Hurricane Katrina) might all suffer, but won't all adopt the same attitudes of victim, surviver or thriver. In a chapter entitled, "Poor me," she mentions several of the potential payoffs for over-identifying with the "victim" point of view: "'Victims' don't have to be responsible for their attitudes and actions;" "'Victims' get others' sympathy and support...for a while;" and "'Victims' feel self-righteous and justified." There's even a short quiz: "After all I've been through, I've learned that you just can't trust people;" "I admit that I have a tendency to blame others when things go wrong in my life;" "I often have pity parties;" "People have told me that I complain too much;" and "I feel angry when people try to get me to make personal changes and begin to move on. They just don't understand."

Contrast those self-defeating sentiments with those in the "Survivor's Pledge," which we wrote about several years ago, here: 

The Survivor's Pledge:

I will not be a victim.

I will rise above.

I will give back.

I will change the world.

There's also an ultra-fabulous chart comparing and contrasting the states of "victim," "survivor," and "thriver" -- with "thriver" being obviously the most desirable state, linked here. A wonderful OIF vet, with MST and PTSD, shared it with me a few months ago, and it's a keeper. When I shared it with the subject of "Eyewitness to Combat," another overcomer, he loved it too, and said, "PTSD is on the left, surviving is in the middle, and healing is on the right." As someone who's experienced all three states, that's how he chose to describe them... Not everyone is at the same place in their healing trajectory, but at the very least, it could serve as some inspiration for what improvement would look like, and how to get there...incrementally.

Quotable Quotes -- The Dalai Lama on Life Purpose and Satisfaction

That Dalai Lama -- he's amazing! If "personal outlook" were a software package, I'd ask for the Dalai Lama upgrade: because I like how he thinks. So compassionate and kind and reasonable, but not afraid of science. A fascinating, compelling combination. 

Some of his great quotes lately:

"We can't be useful to ourselves unless we're useful to others. Whether we like it or not, we're all connected, and it is unthinkable to be happy all by oneself. Anyone concerned only with his own well-being will suffer eventually. Anyone concerned with the well-being of others takes care of himself without even thinking about it. Even if we decide to remain selfish, let us be intelligently selfish -- let us help others." -- The Dalai Lama.

And another:

"Once you shift your focus from yourself to others and extend your concern to others, this will have the immediate effect of opening up your life and helping you to reach out. The practice of cultivating altruism has a beneficial effect not only from a religious point of view but also from a mundane point of view; not only for long-term spiritual development but even in terms of immediate rewards."

And another:

"The world's major religious traditions all give the development of compassion a key role. Because it is both the source and the result of patience, tolerance, forgiveness and all good qualities, its importance is felt to extend from the beginning to the end of spiritual practice. Even without a religious perspective, love and compassion are clearly of fundamental importance to us all."

And another:

"Satisfaction is characterized by inner peace. It arises from generosity, honesty and what I call ethical conduct, a way of behaving that respects others' rights to be happy."

---

Bringing this all back around to veterans with combat-based PTSD and their families, think how crucial what he's expressing are. Eighteen veterans a day kill themselves -- a shocking statistic -- and we seem to be at the beginning, not the middle or the end -- of that particular trend. Army and Marine suicides -- they see the bulk of the action, after all, in these wars -- are both up, despite the "best of intentions" on the part of the services to bring down the numbers. Pep talks on prevention and more prescriptions aren't solving the problem, nor are they likely to. Because, as one combat vet with PTSD said, "pep talks are hard to take seriously because that is for the normal life of a normal person, not for a veteran contemplating suicide because of combat trauma." True, that.

It's coming up on two years, shortly, of my first phone conversation with the combat vet, a Vietnam vet, Marine, with 40 years(!) of severe, chronic PTSD, which plagued his life, despite "all the best" of what the VA threw at him (his words, not mine), including an inpatient, residential PTSD program that was cutting-edge at the time. (Would it surprise you to know that most of his classmates in that program, according to him, are now dead, also from suicide?) After our first conversation, which seemed relatively pleasant and positive, he followed up with an email about wanting to drink and put a gun in his mouth to end it all, because he was sure God hated him; after all, he himself did. Sparkly stuff. Lots of unicorns and rainbows and fluffy clouds there...not one bit.

Of course, the end of his story is quite a bit more positive, mostly because it didn't end. He's made the transition from bleak, grim and grisly to mostly inspirational and awesome. And it took a while, a solid footing, a hand reaching across the abyss and pulling him up and out -- a hand which he importantly grabbed (it doesn't work if you don't ;-). It took some specific therapeutic treatments to help remove trauma from the body. We tried a few, intentionally, and they worked; there are others that might as well. And it took a huge motivation on his part to reach out -- however ugly his mess at the time -- to get some help and be real about where he was really at. For years, decades really, he'd been the one other vets' wives called to take the gun out of the mouths of their husbands. Now he finally had some hope to offer others. But it took commitment on his part, believing that the hope was out there, and going after it with all he had. Not always pretty, but effective :-)

(He's the veteran in the "Eyewitness to Combat" series on the site. Here are two items about his turnaround, linked here and here. The second is in his own words.)

Anyway, the upshot of the whole experience is wanting to build a program to bring other combat veterans with PTSD through, and help their families as well, who are often left holding the bag (of misery) but not really getting the help they need either. Combat veterans with PTSD have often lost their life purpose completely, and as we've been talking about lately, purpose is key.

The "eyewitness to combat" veteran, described above -- he and I share a purpose. It's helping others overcome. It's possible. And as the Dalai Lama says, that's being intelligently selfish -- taking care of those 18 vets a day who'll be killing themselves, BEFORE it happens. So it doesn't HAVE to happen. That's the best use that you and I could put our time and energy and compassion to. Please join in helping others so that they don't have to suffer so intensely, when there is a way out.

Editor's Note: A California-based psychology grad student is doing a Ph.D. thesis on Iraq vets with PTSD and life purpose. If you qualify based on the above criteria, he'd like to talk to you, and will pay you $50 for your efforts if you participate. Here's the link to his study. His brother is a combat vet. 

Additionally, you can "follow" the Dalai Lama on Twitter -- @DalaiLama -- and you can follow us on Twitter as well @HealingPTSD.

Prevention Talk and Prescriptions Apparently Not Doing It: Army and Marine Suicides Both Up

"The grand essentials of happiness," Allan Chalmers wrote, "are something to do, something to love, and something to hope for." Those words echoed in my mind yesterday when I met a remarkable woman vet in Seattle, who ten years ago was homeless, suffering from MST and PTSD. (Today she's a vital, contributing member of her community, solving problems for herself and other veterans in need, on a large scale.) 

We were talking about suicide prevention, a cause close to her heart, because she'd lost a daughter to suicide, and recently a friend as well (Orrin McClellan, who we wrote about recently on this site.) We were talking about suicide, and how Army and Marine numbers are still up, despite prevention strategies. She said, pointedly, that she'd learned that veterans (and others) who are struggling with suicide need "three things" in their lives to keep from killing themselves. What they need are: "a reason to live, a way to live, and a purpose to live for."

Salon magazine had an excellent but gut-wrenching article earlier this week by Mark Benjamin called "A Predictable Suicide at Camp Lejeune," subtitled, "A doctor warned that mental health care for violent, disturbed Marines was inadequate. Sgt. Tom Bagosy proved it." The story profiled the violent death of Marine Sgt. Tom Bagosy, 25, on the way out of the Deployment Health Center. (Bagosy leaves a wife and two children.) Less than a year ago, Salon had run another article by Mark Benjamin about a Marine Corps psychiatrist, Dr. Kernan Manion, and his specific, whistle-blowing warnings about the inadequacy of mental health care at Camp Lejeune -- warnings he took all the way to the president, and seemingly for which he was fired a few days after voicing them. (Here's the link to that earlier article, including his warnings.)

Marines initiated a new suicide prevention program last year; but suicides have only increased. They lead the services at this point. Army numbers are up as well. According to a report released Thursday, and carried on CNN, 32 soldiers killed themselves in June, "the highest number in a single month" since Vietnam. Twenty-one of of the soldiers were active duty, 11 were inactive Guard or Reserve; and seven of them killed themselves while deployed. A quote from the article, "Army officials admit they still haven't answered the question of why troops are committing suicide at a record rate."

While Marines sometimes mock the Army's slogan of an "Army of One" -- preferring instead to focus on the group -- the reality is, both branches are seeing heavy combat and neither one is excelling at helping troops not commit suicide. New programs get trotted out, new initiatives, new videos. But none of them are getting the job done: not alone, not together. Troubled troops and veterans are simply not listening; or not hearing what they need to hear. And what would that be?

Well, Mass. General Hospital is having their second annual conference right now on the "Complexities and Challenges of PTSD and TBI," and they're doing a great job "Tweeting" the speakers' points in real time. Here are a few excerpts of note, starting with a crucial one: "Only 30% of troops self-identify as needing help before committing suicide -- despite all the proactive intervention points." And again: Only 42% of troops who screened positive for mental health problem actually sought help from doc or spiritual advisor." PTSD is initially difficult to distinguish in troops because upon their return home, "initial relief and euphoria" at being back can mask it. But over time,"After 8-10 weeks and adjusting to a different life schedule at home, symptoms start to present."

This fits right in with the stories you hear from people coming back, that they don't want to talk about it or think about it (PTSD); they just want to get on with their lives, and fit right back in to where they were before. It's later on, when this adjustment doesn't work, that things get more stressful. High unemployment can't help: veterans' unemployment is significantly higher, in the recession, even that the national average. And troops have gone from being highly focused on the battlefield and engaged in their warrior purpose to losing that and perhaps not being able to replace it immediately with another. They've also gone from a high level of camaraderie with their buddies often to being quite geographically separated from those they were close to when deployed. Marriages and family life can be rocky as well. The relationship they were dying to get back to on the battlefield may have evaporated by the time they got home; or not make the adjustment intact. Again from the MGH conference: "78% of marriages end in divorce for first-time deployment troops."

Against all these backdrops of difficulty -- and an awareness that the "gold standard" of treatment is still talk therapy and psychopharmaceuticals -- the problem persists, compounded by sleeping pills that can be dangerous, and the ever-present self-medication strategies of alcohol and street drugs. It's hard to get the formula right for the correct medication(s) at the correct dosage(s), and until that happens, veterans frequently talk about feeling numb, in a stupor, not feeling like themselves, etc. Vets don't necessarily want to talk about what they've been through -- except perhaps with one another, and even then, not that much -- and ignorant questioning about how many people they've killed while they were over there, etc., just exacerbates the problem. So enough of the bad news...of which there is plenty...what can vets possibly do to increase their chances of surviving and adjusting? Because I highly doubt it's gonna be another prevention video or poster that does the trick, however well-meaning.

If everyone wants an easy answer, maybe they won't like this. But it seems to be that it's time to return to replacing one purpose (warrior) with another (warrior on the homefront), and putting some time and thought, effort and resources into what that will be. One veteran who made the transition from serving to the fire department, felt he literally replaced his one purpose, and one set of buddies with another; and that "substitution of purpose," as it were, was what helped him survive. But not every vet will be so lucky, or have or make that opportunity. 

If we take a look back at the Chalmers quote that opened this discussion, what are the three "grand essentials" for happiness (i.e., well-adjustment) that he cites? Something to do, love and hope for. And what are the three things that help a vet prevent suicide, according to the suicide counselor vet? Three very similar things: a reason to live, a way to live, and a purpose to live for. Veterans are warriors...and cast aside from their purpose, without an effective way to replace that immediately, it's possible they flounder. As a society, as those who "support" our troops -- whether professionally or personally -- what can we do to make sure that they have all three? With a little reflection, we can see where they had them in combat. Something to do (be a warrior); something to love (family, country, buddies, the mission); and something to hope for (winning; getting back home alive; reuniting with family and friends; keeping your buddies alive). What I suspect, sadly, is that from those adrenaline-charged heights, life on the home front, potentially unemployed, over-medicated, and disconnected from family and friends, there can become a time when there's not enough "reason" to live; there's not enough way to live; and there's definitely a loss of purpose to live for.

A better use of resources than more videos, etc., though would be: focusing on what would it take to give veterans their purpose back? And not entirely how could be do it for them, but how could they join in that mission themselves? Every veteran affects the lives of 50 other people, minimum; so whatever happens with them back on the home front is a ripple effect. Let's focus some energy on the topic of continuing life with a purpose; versus watching on with sadness and despair the continuing tragedy of young vets (and older) taking their own lives. They've given too much; and they deserve so much better. So while pep talks on prevention and prescription pharmaceuticals don't seem to be doing the total job when it comes to suicide prevention, maybe it's time to bring back talk about purpose -- and how to continue that successfully, after the deployment is over and the uniform is hung up for the time being.

In a related side note, apparently mental health plummets when distressed individuals can't "do" to solve their situations with personal effort. There's been talk in the news lately about mental health issues soaring in the Gulf states after the BP eco-disaster, and that money needs to be set aside to help with those; but in that, there's also discussion of what happened after Hurricane Katrina. Apparently, after the hurricane hit, those affected started immediately to do what they could to restore their lives. (Think of all the news footage we've seen of residents after large-scale disasters, sawing up downed trees, hauling lumber to shore up makeshift housing, etc.) What's now surfacing anecdotally are stories about while this busy-ness after the disaster was therapeutic for people -- helped them to get their minds off the tragedy by putting themselves back to work -- when FEMA came through and made everything grind to a halt while they inventoried the situation -- people's grief and despair rose up in waves, with nothing to "do" to distract them.

Much is made of the "adrenaline rush" of combat, and how it's very hard (hmmn, likely impossible) to match that in civilian life -- but at the same time, there's also definite "purpose" -- of getting the job done, of keeping your buddies alive, etc. After combat...it's suddenly very quiet, and boring by comparison. "War is hell, but peace is boring!" some veterans joke. Cast adrift without the shared common and energizing purpose of combat, in their early 20s, veterans need quickly to find something to "do" that matters to them -- something they can live for, love and enjoy, that satisfies them and makes life worth living. Sadly, far too many people are checking out when they can no longer find a reason to live, and in tragic stories like that of Marine Sgt. Tom Bagosy, or Orrin McClellan, you get the impression they don't feel like they had any other choice. Tragic. Not just for them, but for the people they left behind, whose lives will also forever be marked by this experience. Such a tremendous loss...and possibly, preventable: If not for them, at least for some others. Let's try.

Quotable Quotes -- Rob Brezsny on What Qualifies as "Information" on a Subject, Even PTSD

Here's a great quote from American free thinker Rob Brezsny. I like it because it goes to the heart of what we're trying to do on this site. It's not the "same 'ol, same 'ol" -- it's an attempt to get people thinking differently about a topic that ruins many people's lives, yet within which there is still to be found a certain amount of hope.

This website has been going on for almost five years now. Tens of thousands of hours worth of researching, reading, interviewing experts, thinking and composing the almost 800 articles on the site, 200 recommended books, and dozens of experts. We when started, back in very early 2006, there really wasn't anything out there about PTSD and veterans on the Web, for troops coming back from the wars in Iraq and Afghanistan and their families. I Googled it plenty to make sure I wasn't intruding on someone else's "space." In fact, Ilona Meagher was starting her work at about the same time, but Google hadn't picked up either of us yet. A few months later, when I found her site, I made a point not to read it, so that we could each keep to our original point of view, and not be accused of overlap.

I even chose the name, "Healing Combat Trauma," in a fit of inspiration -- because it was expressly intended to give people HOPE, who might be lacking it, or beaten down by the sheer overwhelming nature of what they had, that they could still get better. Something to cling to, that might help move them out of a state of despair, discouragement and demoralization into a sense that there was something still worth looking for, not to mention living for. "Without hope, the people perish" -- the Bible says. It's a very true statement. And there's nothing like illness to make people give up hope, because of feeling poorly in body, mind and spirit.

Today, almost five years later, the "landscape" surrounding this topic has changed quite a bit, but it's also heartening that people are beginning to find that we're out there and like what they see. The need is greater than it ever was. At least 18 veterans a day kill themselves because they've frankly given up, or feel too miserable to carry on, with the "best" of what they've been offered from the status quo (which fortunately is also improving, but maybe not fast enough, or in enough flexible directions to satisfy the need.) I made a decision early on that I didn't want to "just" report the news -- "misery everywhere! report at 11" -- because that was too easy to do, and didn't require any original thought. We're not cutting and pasting here; we're reading, analyzing, thinking, and talking to people who know -- and then sharing that information with you. 

And there's a certain amount of resistance. On Facebook, where there's a fan page for this site, linked here, with approximately 2,500 members, people occasionally recoil in horror when they read the title. "Healing" Combat Trauma? Why, they sputter, you can't HEAL combat trauma -- my doctor said so! And I just saw him. Of course, we've covered that topic, ad infinitum, but the basic interpretation is, there's a difference between "healing" and "curing" -- and healing is a nice continuum of improvement from bad to better that anyone can jump right on, at any given time -- especially when they're ready to, and not a moment before. "Healing" isn't something you want to drag unwilling people into; but it's also something that is available for those who want it, at whatever degree they can access it. (Even the VA, at least at the level of the National Center for PTSD, and their clinical training which I got to attend in May, is talking about switching the emphasis from a focus on "symptomology" to "functionality" with PTSD -- a needed improvement.)

I had the "healing versus curing" conversation many times with the subject of "Eyewitness to Combat," whose own story of great improvement is highlighted here, in his own words. After going to one treatment or another that appeared to improve him, he would be excited about thinking that he was now "cured" -- despite 40 years of chronic, severe PTSD, and having tried most of what VA had to offer, including a stint in an inpatient, residential treatment program for PTSD that was cutting edge at the time. I tried to explain to him, patiently and not always successfully, that healing wasn't a toggle switch between "ill" and "well," but a path from one to the other, which he was now on, and which he'd continue to be on, through the various things that we'd try and the progress that he'd make. It's also something that doesn't always need a practitioner to facilitate. Practitioners are important, but there are also things that a person can do for him or herself, to improve their overall health and well-being. And sometimes it's important to wedge people's minds open just a little tiny bit...in order that they can encounter something new, that might change their world view, which might (ultimately) help change their lives. Worth it.

Which brings us to the quote of the hour. It's an interesting one, because Rob Brezsny hones in on how something people aren't used to -- the idea that you can "heal" PTSD, for instance -- ruffles some feathers, and shakes some people up. But if they already knew it, what would be the point of hearing it again? Sometimes we have to step away from our preconceived ideas about what "can" and "can't" happen to enter the realm of the possible. In sickness, which is so laden with discouragement and guilt -- as well as hype and manipulation, sometimes -- that's no different from any other area. So let's see what Brezsny has to say about what qualifies as "information" on a topic:

"Let's define information as data and ideas that are new to you. If it's something you already know, then it's trivia or propoganda or dogma, not information. In fact, let's be tempted to use the terms "information" and "novelty" interchangeably. If you're not surprised, if your curiousity isn't piqued, then the message streaming your way may not qualify as information." -- Rob Brezsny.

Going to the Bunker: A Combat Veteran with PTSD on the Purpose of Protective Isolation

Every combat veteran with PTSD knows what is meant by their "bunker," or what "going to their bunker" means. It's a walled-off, isolated situation that allows them to get some space to themselves, away from other people (including family and friends), when they feel particularly triggered, and they need to stay in there for, well, as long as they're going to. They come out when they're ready, and not a moment before. Obviously this situation can be very frustrating to others in the vet's life, but for the vet it affords him or her some very necessary, protective isolation.

The rest of us who aren't combat vets with PTSD I suppose could think of it as the vet putting himself or herself in a time-out from the world, by taking themselves out of the mix, and away from people and stimulation, both bad and good. And the time-out will be over when it's over, because they decide when it's up.

The recent Fourth of July with its fireworks that remind many vets of combat was a classic bunker situation. Many, many vets were making plans before the Fourth for how to protect and insulate themselves from being triggered by the fireworks (noise, smoke, crowds). One Gulf War vet with PTSD who had already isolated himself, wrote of putting a pillow over his head and just wanting it to be over, so that he didn't have to experience it. The next day, fireworks all exploded, he was better. But during, he had to be in the bunker. Another combat vet with PTSD, from the Iraq war this time, talked about staying in her bunker for days, making brief provision runs, every fourth day or so, to the grocery store and then...back to her bunker. When she needed to be in her bunker...

The bunker concept/construct is so typical to combat vets with PTSD that I thought I'd ask one who I know fairly well how he'd describe it. He has decades of PTSD "experience" under his belt, and I've also seen him retreat to his bunker at various times. A month one time, a week another time, the last time, a day. Sometimes even a few hours. But however long the episode lasts, during that time: totally unreachable. And realistically, you better not even try...because it just makes the situation worse. 

The more chances I've had to experience this with him, the more certain I can be that, short time or long, he'll emerge from his bunker, when he's good and ready, and with a new and improved outlook on why he went in the bunker in the first place. (For those who don't know, the bunker can be anywhere...a shed, a garage, a spot in the woods, a room in a house, even a chair. But it's sacred, inviolate, untouchable space...and the vet goes there in retreat, partly to spare those around him, but also strongly to get control over what he's feeling. (He or she, obviously.) So I figured he'd be able to offer his personal/expert advice on this.

Here's how the conversation went.

Me: "What typically sends vets to their bunkers?"

Him: "Any situation -– losing a job, losing their cool, a fight with their kid -- that makes them lose control sends them back to their bunker, so they can regain control. It may not be much, but while they're there, at least they have control over that little room they're in."

Me: "What's the longest time you've ever spent in your bunker?"

Him: "A year."

Me:  "!!!"

And then he clarified. (Remember, this is just his opinion, but it's worth sharing, because of the number of vets he knows and has observed, as well as what he knows about himself.) "Each time a vet goes into their bunker, they go in for a longer period of time. Until one time they go in and they don’t come out." (He does know an awful lot of other vets who have sadly killed themselves. That happens in bunkers, too. No wonder families and friends are justifiably concerned.)

The progression he just mentioned...vets spending longer and longer times each time in their bunkers...is actually the opposite of what he's been doing, since I've known him (which coincides with his getting better). Each time he goes to his bunker, it's both less frequent, and for shorter and shorter times each time, to the point that the last "bunker" episode I observed him in was actually only about half an hour.

In the middle of a frustrating conversation, not quite an argument, but one where emotions were high and we weren't communicating smoothly, he "withdrew" to his bunker of self-enclosed, protective space -- without moving from the couch he'd been sitting on. I saw him cross his arms, very agitated, close his eyes, and start doing something that looked like huffing and puffing. Even on an animal instinct level I knew, give this person his space. All the body language was daggers. I stepped away, and a short while later, he bounced back, and resumed where things left off, able to manage the conflict without any undue strain. Turns out what he'd been doing during the huffing and puffing phase was actually deep breathing, to calm himself down and regain control. Very smart. On the outside, he looked furious. On the inside, he was doing what he could to get back under control. As a result, he was able to "emerge" from his bunker in record time -- which speaks to the tremendous benefits of learning coping skills and stress-reduction techniques, as he has.

When I first knew this vet, he talked about what he'd learned at an inpatient PTSD program at the VA years ago. It was the cutting-edge program at the time, and he speaks of it with great appreciation, even though many of the guys he went through the program with sadly did not make it. ("Did not make it" is euphemistic code for "sadly, later killed themselves.") One of the biggest things he learned in the program, according to him, was about "red flags" and "triggers," and how to get away before you make things worse. Heading for the bunker, just like in the description of the vet with the pillow over his head,  is one way to keep things from getting worse. For the vet, that is -- for the family or loved ones, it's very difficult to experience, and hard to ignore, though one of the secrets seems to be, going on with your own life, while maintaining a compassionate (but not nagging) concern for how they're doing.

One of the distinctions he likes to make, though, between what he learned from the behavioral modification skills, above, in the VA program, and what he's learned since then, following more of a healing path, is that now he has some ability to not just "avoid" triggers but also "deal with" situations as they come up. The red flags still show that the problem is coming, but instead of being ONLY triggered, there are now new ways to deal with it that don't only involve avoiding or isolating.

The situation above, of being in conflict but being able to "be" with it, and breathe through it, meant that the conflict didn't have to explode into a multi-day saga or a physical exit to an actual bunker, which could last for weeks or months -- or even a year(!) Ahhh, progress is a beautiful thing...

Editor's note: For Part II, "Busting Out of the Bunker at Last," go here.