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PTSD

June 19, 2009

The Dept. of "No Real Surprises Here": Chiropractic Doesn't Help Veterans Suffering from PTSD

Chiropractic5 An article in the current issue -- June, 2009 -- of Military Medicine takes a look at the effects of chiropractic on veterans with PTSD, and finds the results lacking.  The study is called "A cross-sectional analysis of clinical outcomes following chiropractic care in veterans with and without post-traumatic stress disorder,” and it was authored by Drs. Andrew Dunn, Steven Passmore, Jeanmarie Burke and New York Chiropractic College student David Chicoine.

According to an article in trade publication ChiroEco.com, that study "investigates clinical outcomes for 130 veteran patients with neck or low back complaints at the VA of Western New York. This study found that patients with post-traumatic stress disorder had significantly lower lower levels of improvement than those without post-traumatic stress disorder on self-reported outcome measures of neck and low back disability."

These results are not really surprising, because -- unlike another form of bodywork, massage therapy, which does have proven results for helping PTSD symptoms -- there's nothing about chiropractic per se that indicates it would be helpful. Spinal subluxations, while combat veterans may be experiencing them, aren't really part of the PTSD profile, and relieving them wouldn't necessarily have any effect whatsoever on reducing PTSD symptoms.  They're just not related. That said, it's progress that chiropractic is offered in military health care settings, and we're sure it brings combat veterans some relief -- in the appropriate context, which PTSD is not.

For a look at complementary and alternative medicine therapies ("CAM") that have shown benefit in treating PTSD, click here.  For a look at bodywork therapies, click here.  For a look at mind-body medicine approaches, click here.  To read the article in ChiroEco.com, click here.

June 07, 2009

"Anything is Subject for a Poem" -- Even Combat and Its Aftermath

It's hard for me to believe I haven't already posted this, but that's what the blog search says -- and I must believe it. Here's an interesting item from the always-fabulously-insightful Den Ming Dao, on how "anything is subject for a poem," and why a regular discipline of "writing down the bones" can be advantageous to any of us, even -- or especially -- combat veterans.  He writes:

Anything is subject for a poem:
A catalog of boxing equipment, a collage of other poems,
Serpentine trail of incense, raised deer fur, old shoes pointed pigeon-toed,
Glass and steel cityscape, almond eyes of a saint, weeping tiny flowers,
Sunlight on whitewashed walls, blue shadows of stooped women,
A spring mousetrap, a trickle of blood in the gutter,
The homing swoop of a gull, chill white-capped bay, scent of eucalyptus.
Green lawn of broken blades, clods of fat earth.
Anything is subject for a poem.

Even in sleep, write a poem.
When waking, write a poem.
While loving, write a poem.
Even voting, write a poem.
When angry, write a poem.
While dreaming, write a poem.

The sages say quite seriously that those who wish to know better should cultivate the poet in themselves.

-- 365 Tao: Daily Meditations, by Den Ming Dao.

May 26, 2009

Upcoming Seminar on Warrior Health: PTSD, Depression and TBI

The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., presents:

A Center for Deployment Psychology Training Program:

"Addressing the Psychological Health of Warriors and Their Families: PTSD, Depression and TBI."

When: Mon 22 Jun 2009 through Fri 26 Jun 2009.

Where: The Cheyenne Mountain Resort, Colorado Springs, Colorado.

What: This intensive course, which is comprised of 4 modules, will train civilian mental health providers to better address the behavioral health needs of military personnel and their family members throughout the deployment cycle.

Who: The intended audience is civilian mental health providers who provide behavioral health care to the military population or military family members, including veterans and their loved ones.  This training is NOT intended for active duty military providers, but rather for civilian or private practice/community providers.

Supported by: Fort Carson Soldier Readiness Center, National Organization on Disability, Operation TBI Freedom and Regis University.

For more information about this upcoming seminar or to register online, click here.

May 21, 2009

A Harvard Study Confirms More Combat Exposure = More PTSD

Harvard_U_Shield The Atlantic magazine this month has a story about the Grant Study, a longitudinal study which followed 268 "Harvard Men," from the classes of '42, '43 and '44, from their sophomore year in college, through for the next 42 years.  The Grant Study men, those who are still alive, are now in their 80s, and approaching death. It wasn't the purpose of the study, but because so many of the men served in World War II, the study was able to comment that, among other things:

"More than 80 percent of the Grant Study men served in World War II, a fact that allowed (the study's administrator) Vaillant to study the effect of combat. The men who survived heavy fighting developed more chronic physical illnesses and died sooner than those who saw little or no combat, he found. And “severity of trauma is the best predictor of who is likely to develop PTSD.” (This may sound obvious, but it countered the claim that post-traumatic stress disorder was just the manifestation of preexisting troubles.)


The full story, called "What makes us happy," by Joshua Wolf Shenk, is linked here.

May 20, 2009

Hanging Tight to the Narrative, to Pull You Out of Hell...

Rope More Tyler Boudreau, from "Packing Inferno: The Unmaking of a Marine," on why he writes:

"They say war is hell, but I say it’s the foyer to hell.  I say that a lot.  I say coming home is hell, and hell ain’t got no coordinates.  You can’t find it on the charts, because there are no charts.  Hell is no place at all, so when you’re there – you’re nowhere -- you’re lost.  The narrative, that’s your chart, your own story.  There are guy who come home from war and live fifty years without a narrative, fifty years lost. They don’t know their own story, never have, and never will.  But they’re moving amidst the text every day, and every long night without even realizing it.  They’re out there beyond the wire, trudging through the sentences, tangled in the verbs, suffocating on the adjectives, wrecked by the names.

They live inside the narrative like a cell, and their only escape is to understand its dimensions.  Once you get it, maybe you can start tearing down the walls.  Every soldier’s mind is different.  There is no single code to break.  It’s ever-changing.  I don’t have a recipe, but there’s one thing I do know, and that is the power of the narrative.  Put the story together.  Understand the story.  Ask questions of the story; make it answer you.  Make it.  You don’t take no for an answer.  You keep building that narrative until the answer comes around.  That’s the low road out of hell."

Okay, the low road out of hell: Maybe. It's not the first time someone's thought that telling their story -- just getting the words down on paper -- would have curative powers.  Read another Marine captain, Nate Fick's, essay for Powells, the great used book store in Portland, Oregon, about why he wrote "One Bullet Away: The Making of a Marine Officer."  See other veterans from other eras -- for example Claude Anshin Thomas, who wrote At Hell's Gate: a Soldier's Journey from War to Peace -- as they grapple with the narrative, to pull themselves to safety -- or sanity.  See and feel the way they fight for it, with every breath, with every word on the page. The same goes for the veterans who are the authors and the poets in Maxine Hong Kingston's anthology, Veterans of War, Veterans of Peace. Many,  many people feel...that this way lies redemption.

Or does it?

A little over a year ago, I was "gifted" with a narrative worthy of a Charles Dickens, if Charles Dickens had been to war.  Forty years the combat veteran had spent, trying to crack his own case (of severe, combat-induced PTSD), trying to get it all down on paper.  To make sense of it for himself, to make sense of it for his family.  And 40 years is not an insignificant amount of time.  He followed the narrative, all right; he clung to it like a rope.  But you know what?  All it did is lead him to the precipice of healing.  It wasn't even the precipice itself. What it did do was, in a way, detail the exhausting of his options, and get him in touch with the many things he'd tried -- including, in his case, religion -- so that he could he could continue the search, this time going even deeper.

Ironically, and we had several conversations about this -- he never finished the narrative, even after 40 years.  He didn't finish it, and he couldn't finish it -- we eventually agreed because it was his LIFE, and there was no real need to sum that up as though it was already over, because it wasn't.  It, and he, were still very much "a work in progress." And there weren't any simple answers, that would put everything into perspective.  Not for the combat veteran, not for his family either.  It was a pretty good narrative of what he endured, and the sense he was able to make of it.  But it was not in any way curative, though getting it down on paper was powerful, and compelling, and both moved his readers -- and himself.  It moved his readers (including his family) towards empathy, or a better, deeper understanding of what he'd gone through.  And it moved himself to continue going after the true prize, which was healing -- not just setting down what he had experienced.  IF writing were truly curative, we'd see more mentally unbalanced, yet otherwise fabulous authors experience "the cure."  (And one has only to think of the great Virginia Woolf, her pockets loaded with rocks, headed into the water to drown herself, to reflect on the apparent wisdom encoded in that statement.) What writing is, or can be, is deeply cathartic.  What it isn't, is the actual "cure."


May 19, 2009

Feel Like Just a Number / War's Psychic Toll

The New York Times has a good op-ed piece today by Bob Herbert, entitled "War's Psychic Toll," linked here.

One point he makes, in the wake of the shooting deaths at Camp Liberty, is that:

"The fallout from the psychic stress of the wars in Iraq and Afghanistan has been vast, but there was no reason for its destructive effects to have surprised anyone. There was plenty of evidence that this would be an enormous problem. Speaking of Iraq back in 2004, Dr. Stephen C. Joseph, who had been an assistant secretary of defense during the Clinton administration, said, “I have a very strong sense that the mental health consequences are going to be the medical story of this war.


He also further clarifies a point that a number of people have been making over the last several years, which is that an all-volunteer military concentrates the inevitable "psychic toll" of warfare into too few combatants on our side.  Herbert writes:

"Because we have chosen not to share the sacrifices of the wars in Iraq and Afghanistan, the terrible burden of these conflicts is being shouldered by an obscenely small portion of the population. Since this warrior class is so small, the same troops have to be sent into the war zones for tour after harrowing tour.

As the tours mount up, so do the mental health problems. Combat is crazy-making to start with. Multiple tours are recipes for complete meltdowns."


We've already seen, in previous blog posts, how more combat => more opportunities for PTSD. The relationship is direct.

At some point, with the same people serving multiple deployments, being injured becomes a numbers game.  And increasingly servicemembers who keep going back, if they've managed to avert injury so far, become concerned that their luck can't hold out forever.

A Recon Marine, with multiple deployments under his belt -- some would say, the toughest of the tough -- headed back to Afghanistan on Monday.  "I'm scared," he told his friends and family, unashamedly.  War is a dangerous game, and multiple deployments wreaks havoc on those who go, and those who stay behind and wait.

---
In the old Bob Seger song about working on an assembly line, "Feel like just a number," he sang, "I feel like just another / Spoke in a great big wheel / Like a tiny blade of grass / In a great big field."  Seger insists he's gonna "cruise out of this city / Head down to the sea / Gonna shout out at the ocean / Hey its me!" "I feel like a stranger / A stranger in this land," he sings.  "I feel like a number / But I'm not a number / I'm not a number -- Dammit, I'm a man! / I said, I'm a man."

I recall a conversation with another Marine, who between tours of Vietnam, had a premonition that he wouldn't survive his second tour.  What worried him even more than the dream was that everyone he knew who'd had a dream like that, and shared it with his buddies, subsequently was killed.  This Marine talked it over with his dad, a heavily-decorated Army officer, who told him, in sort, to buck it up and suck it up and go back -- because if he didn't, he'd be running from every other experience like this in his life.  Well, the premonition had a lot of weight to it -- he was shot multiple times and almost died, and took years to recover from his injuries. So we know that the Recon Marine in today's story, headed back to Afghanistan, does have something to be worried about -- even if he hasn't had a dream like this.

Ultimately, whether he and servicemembers like him think of themselves as "just a number" in the larger war machine or not, their more pressing concern, with multiple deployments in harm's way, is whether this time their number is going to be up.  And let's hope it won't be.  But of course, for society at large -- who stays behind -- the broader public health worry is that even if these warriors come home relatively "unscathed" -- in body, more likely than in mind -- their struggle with dealing with the after-effects of combat will just have begun.

Editor's note: To listen to the Bob Seger song mentioned above, on YouTube, click here.

Puget Sound Veterans Hospital Tries Meditation for PTSD

The Seattle Times reports in today's paper that a veterans hospital in the Seattle area is trying a version of mindfulness meditation for combat veterans with PTSD.  The article is called, "Seattle hospital teaches meditation to troubled vets," by Michelle Ma.  The eight-week course, which has been held for a year, has proved to be of some value to veterans, and current plans are to study the effects more in-depth. 

The article in the Seattle Times is linked here.

For links to other posts we've done about mind-body medicine, including meditation, and PTSD, click here.

May 18, 2009

Upcoming Seminar: War and the Soul, with Edward Tick, Ph.D.

Eastham Three Sisters Light An upcoming seminar that may be of interest to readers is Edward Tick, Ph.D.'s week-long "War and the Soul: Healing Post-traumatic Stress Disorder," put on by the New England Educational Institute, and hosted at Eastham, on Cape Cod, Massachusetts.

(As a Cape native I can say, that's an extremely popular place in the summertime -- make your reservations for accommodations early, if you're considering going.)

From the brochure:

Edward Tick, Ph.D., is Founding Director and Senior Clinician of Soldier’s Heart: Veterans’ Safe Return Programs. Honored for his groundbreaking work in the holistic and community-based healing of veterans and Post-traumatic Stress Disorder (PTSD), Dr. Tick has been a psychotherapist for 33 years, specializing in working with veterans since the 1970s. He is the author of Sacred Mountain, The Practice Of Dream Healing, The Golden Tortoise, and the award-winning book, War and the Soul.

 Dr. Tick is an internationally recognized expert on veterans, PTSD, and the psychology of military-related issues and has conducted training at Walter Reed Army Medical Center and other Department of Defense facilities. He lectures throughout the world and leads semi-annual international educational, healing and reconciliation journeys to Vietnam and Greece. Dr. Tick specializes in using psycho-spiritual, cross-cultural, and international reconciliation practices to bring healing to veterans, communities and nations recovering from the traumas of war and violence.

Click this link for more information, or to register.

The schedule for the seminar, also from the brochure:

Symposium Schedule:

Monday:

  • The universal dimensions of the war experience;
  • Introductory stories from veterans of several wars;
  • What we mean by the soul and its place in psychotherapy and healing;
  • What war does to the soul;

Tuesday:

  • Post-traumatic Stress Disorder from Vietnam to all wars;
  • World history of PTSD;
  • Mythology and PTSD;
  • Warriorhood: Archetypal, cross-cultural and historical perspectives;
  • The Hero's Journey, Initiation, and the Warrior's Path;

Wednesday:

  • A holistic understanding of Post-traumatic Stress Disorder;
  • Stress and anxiety disorder;
  • Identity crisis;
  • Interrupted initiation;
  • Social disorder;
  • Attachment disorder;
  • Soul wound;

Thursday:

  • Traditional and cross-cultural models and practices for healing from war;
  • Purification and cleansing of the warrior;
  • The healing power of storytelling;
  • Restitution in the family and nation;
  • Initiation as a warrior;

Friday:

  • Healing beyond the therapy hour;
  • Unique spiritual dimensions of healing from war;
  • Healing through spirit principles and practices;
  • Healing in the community;
  • International healing;
  • Spiritual vision regarding war and its healing.

May 17, 2009

PTSD, Suicide and the Primary Importance of ... Sleep

Bed There's a great article in today's San Antonio Express-News by Sig Christenson, called "War Lingers, GI Suicides Rise."  (The article is linked here.)

It quotes my favorite, retired Veterans Affairs psychiatrist, Jonathan Shay, M.D., Ph.D., and it quotes him on, among other things, the absolute primary importance of SLEEP, which we've talked about many times on the blog before. (Click here for a link to those posts, many quoting Shay himself.)

Quoting Christenson's article, from today:

"The armed services' high operational tempo for the past decade definitely is part of the problem, said (Jonathan) Shay (M.D., Ph.D.). Though alcohol abuse “is a major risk factor,” he said the military's rapid training and deployment cycles short-change troops on the one critical ingredient to good physical and mental health: sleep.

“I've been agitating for years the importance of getting truly realistic policy on sleep,” Shay said. “This is a slow slog because it is so contrary to the macho culture and so contrary to the self-sacrificial culture, which sees self-care like sleep as self-indulgence.”

Let's recap some absolute basics about sleep:

  • It's absolutely necessary for mind and body healing, and down regulation of bodily systems;
  • It's vital for decision-making and mental health. Studies on drivers who operate on lack of sleep of sleep show that it impairs functioning to the level of alcohol intoxification.
  • It's hard to get in a war zone, for any number of reasons: from the operations that go on for days and nights at a time, to the noises of combat, etc.;
  • It's hard to get after combat, thanks to nightmares, hypervigilance and arousal, and often the desire to avoid sleep (which brings on intrusive memories, nightmares, night sweats, and the like);
  • Chronic lack of sleep impairs mental, physical and emotional health;
  • And yet without adequate, nightly sleep -- how is healing going to take place?

There's a great story told about beloved Marine veteran, Travis Twiggs, who we've written about in other contexts.  Apparently his nickname was "War Pig," and it was given to him during a tour of duty at Guantánamo Bay, where after being up for umpteen hours straight, and finally getting a break, he had fallen into such a heavy sleep that he couldn't be roused, and a passing a general had stuck over his sleeping form a sign that said, “Here Lies the Mighty War Pig.”

I know another hardcore combat veteran and former Marine who came with me once to a program that was designed to help people learn how to sleep better.  He bitched and moaned while we were there, quite a bit, about how this wasn't really suited to combat veterans like himself, but whatever -- he persevered, and tried what they had to offer.  The next day, after he flew home, I worried about him because I hadn't heard how he was doing. A day later, he called me back. "I came home and slept for 31 hours straight," he said.  "I hadn't been able to sleep more than two hours at a time since before I left for Vietnam." So my guess is that the method was of some help to him ;-) But imagine not sleeping for more than two hours at a time?  How well would you be able to heal?

Editor's note: Read the rest of the articles we've included about sleep, from previous posts, linked here.

When the Darkness Has Fallen...Just Me, in the Wake of Battle

Tyler Boudreau I've been reading Tyler Boudreau's "Packing Inferno: the Unmaking of a Marine."  Probably a wise choice, in light of the news recently about combat stress and how servicemembers do and don't tolerate it.  I was drawn to reading Boudreau's book because I'd read several of his essays recently, and pretty much felt like they didn't go far enough -- and I was trying to understand the backstory.  His backstory, that is.  And how better to do that, than to actually read his book.  Boudreau comes across well, as he earnestly attempts to untangle the ordeal of his experience, both serving and (more to our point), coming home.  Within the first ten pages of the book, he's already described his PTSD, and it's a nice, succinct, almost poetic expression, which will help others who don't quite understand it yet.  Here it is, in Boudreau's own words:

"I’m hemmed into the night.  My brain has come to prefer the darkness.  I can’t say with any certainty if this is a product of never sleeping – that is, if it’s just a bad habit I’ve got to break – or if there’s something else going on, like the systematic avoidance of those bloody dreams.  I told the doc I wasn’t sleeping when I got home, and he glanced (up) casually from his desk and said, “That’s normal.  It’ll pass.”

Normal, he said.  When I told him I was just about jumping out of my skin every time I heard a loud noise, he said that was normal, too.  Normal, as in commonplace, as opposed to, say, pathological, like it would have been abnormal not to jump out of my skin.  It’s what they expected from me.  They figured I was in good working order, I guess.

Then they blew off my rage with the same line. “Everybody’s got that,” they said.  I wonder if they’d call me normal now, with all that I’ve got to say.  Three years later, my heart was still pounding, I was still raging, and I still wasn’t sleeping.  I was up, thinking about the war.  I finally told myself it’s like a bad back or a trick knee; you just learn to live with it and you walk. on.  So as I’m walking on, night after night when the darkness has fallen, and the rest of the world is silent, I go looking for my narrative."

(The narrative is something we've talked about earlier, here, and in Boudreau's case, we'll also talk about again -- but later, in another post.)  Suffice it to say, he finishes the foregoing description with a very potent, and poignant, explanation of who he is right now:

"The Marine Corps made a schizophrenic out of me, figuratively speaking.  I used to have only one voice, one point of view.  All right, so I’ve got a new perspective now. It happens.  But it’s not like I changed my mind.  My mind changed.  It split, two, three, and four ways over.  Now there are voices coming at me from all sides.  There’s no coherence to them, and no clear distinction either.  There’s the angry voice, and there’s the broken-hearted one.  There is the tender me and the savage.  And of course, there is the Marine.  There will always be the Marine, standing tall inside me, speaking smartly about values and patriotism.  There there’s all the rest of me, the part of me that was left over when I left the Corps.  He has no name, no identity, or credentials, or skills.  He has no title or rank.  He has no cause.  He is just me in the wake of battle."

With these words, both simple and profound, Boudreau expresses many, many combat veterans' experiences, that they will often spend decades trying to come to terms with, often failing, sometimes succeeding, and sometimes also killing themselves, in a forlorn attempt to, ultimately, attempt to bring resolution to that exact conflict.  Not the external one, in which they were involved as a warrior; but the internal one, with the battle that continues to rage, that they often feel they cannot escape.  Good for Boudreau for putting words to his experience, so that others -- veterans and the public at large -- can relate.

Editor's note: Boudreau's book, "Packing Inferno: the Unmaking of a Marine," is linked here.

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