Healing Combat Trauma

Attemping to Cover Up the Pain Like a Blanket

More reflections from Claude Anshin Thomas:

 

"So you see that the war is not over; it never ends.  My involvement in this war has scarred me in many wars.  It scarred my body, it scarred my heart, it scarred my soul.  The reality of this war lives with me today.  It doesn’t go away.  There is no sense trying to hide it, because war does not go away.

 

 

 

 

Vietnam was the first war after which society could not sweep its soldiers’ pain and anguish under the carpet of heroism and adulation.  The defeat and shame of that war have allowed us to see more truthfully the defeat and shame of all war and all violence, but Vietnam veterans have paid a heavy price for this truthfulness.

 

 

 

The embrace of family and friends and the celebration of ticker tape parades can seem to justify much hardship and cruelty.  But as I have been able to interact more and more with people of my father’s generation, I have discovered just how many veterans from the Second World War spent their entire lives isolated from their families, suffering in silence.  They have spent endless hours in the garage or the basement alone, many of them – like my father and other veterans I grew up with – attempting to drink away the guilt, the shame, the confusion, the fear, the anger, all the feelings of lack of feelings that are the reality of war.  These men are trapped in a code of silence, and many of them are dying there.

 

 

 

The military teaches you to dehumanize, but much in our society also teaches us to dehumanize.  And once you dehumanize, once that becomes a habit, it doesn’t change easily.  When we dehumanize others, we lose our humanity.   This doesn’t just happen in the military: it happens through television, in the movies, in the magazines; it happens on the street; it happens in stores and in the workplace.  Those who haven’t served in the military are confronted with very similar kinds of issues.  Think of those shootings in schoolyards, people beating someone [else] to death because the person is gay, road rage.  Even just shouting at someone in a checkout line because we can’t tolerate the uncomfortable feelings that can arise when we have to wait. 

  

 In many life experiences, we are dehumanizing others and being dehumanized The war in Vietnam, the war in the Persian Gulf, the war in Kosovo, the war on the streets of [South Central] Los Angeles, Hartford, Denver, Cleveland, or any town, the wars that take place in our homes – what are the seeds of those wars?  Vietnam is only an expression of something that beings inside each and every one of us, male or female.  We all possess the seeds of violence, the seeds of war.

 

 

When I entered a rehabilitation center for drug addiction in 1983, I was able to stop using drugs, stop drinking.  After I stopped using drugs and alcohol, the obvious intoxicants, I began to be able to learn what the other intoxicants were that were preventing me from looking at myself.  And I began to stop using those things also.  I stopped using caffeine, I stopped using nicotine, I stopped eating processed sugar, I stopped eating meat, I stopped going from one relationship to another.  I kept coming more and more back to myself, in my commitment to heal, even though I did not understand (in any intellectual way) what it was that I was doing.

 

 

In 1990 it became impossible for me to hide from the reality of my Vietnam experience any longer.  Vietnam was not just in my head; it was all through me.  I had talked intellectually about Vietnam, but I had never fully opened myself to the totality of the experience.  Now the pain reached a point where it was so great that I only wanted to hide from it, to run from it yet again.  My first thought, of course, was to get drunk.  When I drink, it covers the pain like a blanket.  But under the blanket, inside me, is full of barbed wire; every time I move it cuts at me, tears my skin.  When I drink, I have the illusion that I have put a buffer between my skin and the barbed wire, but this is not the truth; when I am anesthetized, I am just not so aware of the ripping and tearing…"

 

--  from At Hell's Gate: A Soldier's Journey from War to Peace, by Claude Anshin Thomas.

Accessing Your Built-In Healing Mechanisms after Combat

It's safe to say that Patience Mason is a one-woman, cottage industry of helpful materials about dealing with PTSD.  Married for umpteen years to a Vietnam veteran with PTSD (Robert Mason, author of Chickenhawk), Patience has learned many life lessons of tremendous value to veterans. Along with Kathie Costos, Aphrodite Matsakis, Ph.D., and a few others, Patience Mason is one of the women who've given the most to helping vets and their families to recover from "combat trauma."  Read her helpful suggestions, below, and notice the emphasis on mind-body medicine, and in particular, mindfulness meditation.

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"Since PTSD can also be triggered by subsequent events throughout the rest of your life, it is wise to learn how to heal. Many older veterans have lost their friends and families because of the struggle to hide symptoms and seem fine. The current war has also re-triggered PTSD symptoms in many older veterans because they remember. They know what you’re facing. If this has happened to you, don’t think treatment didn’t work. It worked before and it will work again. Go back for more.

Each symptom of PTSD develops from a bodily-based, God-or-evolution-given built-in survival mechanism, designed to keep you alive. We all have these survival mechanisms, and if we had been through what you have been through, we would also be affected. You learned these survival mechanisms under the hammer of war.

When you are ready to get better, you have to learn what they are, when and how they are useful, and new skills for when they are not. Each met a need, usually for survival, and finding other ways to meet your natural needs for safety and security is the job of recovery.

We also have built-in healing mechanisms. Attention (eye contact, being listened to, receiving empathy and respect), telling your story, safe touch, acceptance (bad things happen; they are painful), crying, making a contribution (working for the common good [altruism] and to support your family), justice, and spirituality are some of our built-in healing mechanisms. Our culture finds some of them awkward.

While avoidance strengthens and perpetuates PTSD symptoms, it is much less painful than the work of healing, especially if you have lost buddies, your sense of yourself as good or competent, and/or have shame or guilt or despair associated with the trauma as most people seem to. Somehow feeling like it is your fault, and if only you had done something, it wouldn’t have happened, makes you feel less powerless. The essential ingredient of trauma, however, is that it is overwhelming and you are powerless. No one can stop bombs or bullets with if-onlys. Many people spend their lives after trauma waiting and wishing for a better past, instead of working through the pain and anxiety for a better future.

Exposure is the basic task for healing PTSD. It teaches the parts of your brain that don’t speak English and can’t tell time that it is over. Exposure to what you are avoiding in small safe doses with a trained trauma therapist makes a huge difference. Often this is telling parts of your story again and again so that details come back and you can comprehend the whole experience. If you want to avoid these details because you think whatever happened was your fault, talking can help with that, too.

Most vets feel that if they ever let themselves feel, it would destroy them, but numbing bad feelings means the good ones are gone, too. Healing means you learn how to sit with a feeling and let it peak and fade, so you can process your memories. You went through hell. The feelings will hurt, but they will also pass eventually. Your therapist can teach you how to identify your feelings, that you are not your feelings, and that other people can have different feelings without either of you being wrong.

You can even learn to go in and out of numbing, since it can be handy, as can many of these survival skills. If you have developed an addiction to help you maintain numbness, you probably need to get clean, sober or abstinent from the substance or behavior.

The best way to deal with non-verbal memories is to move them from the non-verbal parts of the brain up to the frontal lobes and turn them into narrative memories, in other words: remember. Writing and rewriting something that happened to you is one way of doing it. Talk therapy is another. You get to tell your story. This is painful but you made it through the event, and you can make it through the memory.

For hyper-arousal, I always suggest basic un-training. Every soldier I’ve ever met thinks the military taught him to take care of himself. “Oh, really?” I often say, “So you used to say to your drill instructor, ‘Sorry Sergeant, I can’t do that. I need a nap.’” This usually gets a big laugh, but that is the kind of self-care you need to learn. After you have been to war, there are some things you simply can’t do. Sometimes it’s parties (don’t bunch up), cookouts (burning flesh), family fights. Sometimes it’s “Don’t ever come up behind me and grab me.” Whatever it is, learning to speak up is important. You have to learn self-soothing methods, so you’re not always yelling and angry.

You have to expose yourself to triggers in small safe doses, too, so they lose the power to trigger you. Learning that what triggers you is not necessarily dangerous here is also important, so your family doesn’t have to avoid your triggers.

Learning to meditate helps with these tasks and keeps you present in the present. The book Wherever You Go, There You Are, by Jon Kabat-Zinn helped Bob a lot. He also reads Thich Nhat Hanh. [Editor's note: Claude Anshin Thomas likes his work very much.] You may also find ways to heal your body’s constant state of tension through somatic therapies or yoga.

You may have to heal your beliefs. During extremely traumatic events, such as having a buddy die in your arms, or get killed when you weren’t there, people often decide “I will never love anyone again” or “I should never have left” or “It’s my fault.”

Other beliefs that can interfere with healing and with everyday life include ideas like “Don’t talk about it,” “Only weaklings and whiners ask for help,” “You can’t trust anyone who wasn’t there,” and its converse, “You can (and must) trust anyone who was there.”

PTSD can make you feel totally out of control. By choosing to take new actions which have worked for others, you can regain that sense that you are in charge of your life."

-- Home from War, by Patience Mason.

 

Couples Massage: Sensual Seduction or Stress Reduction? You Decide

We mentioned aromatherapy or making "potions" or blends of essential oils the other day -- not that horrid fakey stuff that's sold in the supermarket, or the dead stinkpots of "potpourri," looking like what's left over after someone dredges a pond, boiling away on somebody's stove (yuck...) -- the REAL STUFF, which is tremendously lovely to experience. 

Essential oil blends can be amazing to smell, and reputedly have some therapeutic properties, especially for stress reduction -- but imagine how great they could be if you could combine them with a lovely, tender massage?  Giver or recipient: it's hard to say who has the better time.  And if you switch off, both get to enjoy.

When it comes to aromatherapy, Valerie Cooksley, who we talked about here, is the recognized expert.  She has a few great recipes "for lovers" in her book, but here's one that's specifically for massage. 

Says Valerie, "Here is a very sensual massage oil designed for the whole body (2% dilution). I suggest warming the oil in a hot water bath prior to application to increase absorption.  There is enough here for two bodies, so decide who will go first.  Review the helpful tips for aromatherapy massage [in her book]...If this oil appears too strongly scented, simply add more vegetable oil (the sweet almond or the safflower) to dilute it:

4 Tbsp. sweet almond or safflower oil

1/2 tsp. Evening primrose oil (optional)

1/2 tsp. carrot seed oil (optional)

12 drops Sandalwood essential oil

6  drops Ylang Ylang essential oil

4 drops Clary Sage essential oil

2 drops Rose oil (for dark hair and skin) or

2 drops Neroli oil (for light hair and skin).

Directions, according to Valerie: Mix the essential oils with warm safflower or sweet almond oil in a shallow dish.  Apply to the body in small amounts using a comfortable pressure and working toward the heart.  Avoid the face  and genital area.

Her book also includes several bath recipes with "aphrodisiac qualities," and a very special inhalation recipe. (For the uninitiated, essential oil blends, depending on their specific properties, can be appropriate for sniffing, dabbing on the skin, adding to a bath, adding to a carrier (lotion or oil), etc., but usually each blend -- because of its constituent parts -- is suitable for one, not a variety of those uses.  Hence why it pays to learn more about this topic, and picking up a book like one of many Valerie has written is just the way to go.)

Editor's note: If you don't know how to give a really great massage, pick up a book, watch a DVD, or take an adult education class in your area.  The essentials oils are typically available (Aura Cacia is a good and reputable brand) from various decent health food stores (Whole Foods, Wild Oats, etc.) plus online at Amazon.com and at Frontier Organics, among others.  Image is by German photographer Thomas Wanhoff.

Heart Un-Healthy: Study Shows PTSD Bad for Combat Veterans' Hearts

A Reuters story on Wednesday, citing a study in the July/August issue of Psychosomatic Medicine, raised PTSD as a risk factor for cardiac disease.   (That story is linked here.)

The study was done with Vietnam veterans, and it showed that once other factors were accounted for, PTSD caused twice as many study deaths from heart disease as researchers  expected.  The upshot of the study is that veterans with PTSD should try to overcome their PTSD as early as possible, through counseling and whatever other means prove effective (that wasn't really part of the study), because otherwise, PTSD continues to raise health risks decades after it first shows up, as it has with these Vietnam veterans, who are now in middle age.

PTSD: it's not good for your psyche, and it's not good for your body either.  The best thing you can do, if at all humanly possible, is find ways to move through it, so it harms you as little as possible. WAY easier said than done, we realize.  This study, however, is just another reminder -- not that we needed one -- that combat trauma/PTSD are not good for human beings to suffer: not at first, and not later.

But you know... if there were ever (another) good reason to check into something like "Mind Body Medicine," which we've talked about on the blog here recently, this is one of those opportunities.  Even hearing something like "PTSD [which you couldn't avoid; you were in combat] raises your risk of heart disease [which by implication you can't avoid, now that you involuntarily have PTSD] -- or the even cheerier "raises your risk of early death!" [lovely...] is plenty stressful.  And chronically elevated stress levels, don'tchaknow, aren't good for your heart (or your health in general.)  The good news is, there are things you can do for yourself, in addition to whatever your doctor prescribes, that are low-tech, sometimes even high-touch solutions, that can create more peace and calm in your life with which to face whatever crises you may have, including health ones.  Don't just let this news discourage you: let it prompt you to look into all of what your options are, for a healthier, and ideally longer life.

Healthy Sexuality for Combat Veterans: The Tao of Healthy Sex

The topic of healthy sexuality for combat veterans that we started talking about yesterday, here, is so huge, and is going to have to be covered in so many ways, over quite a bit of time, in order for it all to sink in, and make sure it's all covered.  Unfortunately, before we get to the "good stuff," as they say, we still have to cover the "bad stuff," because there's quite a lot of that. And by "bad" we're not even meaning, the criminally bad stuff -- military sexual trauma, already covered, here; and domestic violence, already in progress -- how to leave someone with PTSD when you've really gotta go, no matter how much you love the veteran, because your safety and life are at risk.  That's another thing we're gearing up to talk about on the blog, and then we'll be "done" with this overall, comprehensive topic of "things related to sex and the veteran, both bad and good." 

However, all we mean for the moment by "bad" is the stuff that plagues combat veterans' lives, and that of their partners, and shuts them down, and kills off the potential for great, nourishing, healthy, supportive, mutually affirming sex.  Which of course is one of the very currencies of existence, and without which people's lives, and psyches, essentially begin to wither up and die (true, not just poetically speaking.)  Combat veterans bring an awful lot of baggage to this equation; but their partners sometimes do as well.  Or their partners develop some resistance, based on the other things that are going on in the relationship with the veteran. The unhappy "dance" of abstinence, rejection, emotional numbness, resentment and neglect (among others) can be a sad waltz that both partners know too well, and from which there seems very little chance or hope of freeing themselves.

That said, it's not surprising that if we step away from the whole "landscape" of inadequate, inferior, and ultimately unsatisfying sexual experiences, fraught by the problems combat veterans and their partners can experience (other people can too, but we're talking about them right now) -- that we have to look "elsewhere" to get a cleansing breath of "fresh air" about what healthy, balanced sexuality could look like.  Not sexuality that's based on compulsion, addiction, or effective bargaining tools: but sex as an affirming life-force between two mutually consenting, and non-addicted personalities.  From Den Ming Dao's beautiful book once again, 365 Tao, and as you reflect on it, consider how many filters he's saying that we view healthy sexuality with, that ultimately serves to ruin it for the participants.  Of course, it doesn't have to be that way: What we put into love determines what we get out of it.

Between the Sheets: Healthy Sexuality for Combat Veterans

This is going to be the beginning of an extended cycle of posts on "healthy sexuality for combat veterans," a subject that desperately needs to be addressed.  There's too much to cover in just one sitting, though, so stay tuned for a few here because we're first going to have to cover the problem, in depth, before we can turn to some of the solutions.  It's really pretty surprising that no one is talking about this stuff professionally -- other than the veterans themselves, if they can ever work up the courage to.  So here goes. I have my "focus group" of veterans: they're telling me what they want to hear discussed out in the open.

You'd be surprised, as I was, if you reviewed the literature on veterans and PTSD, and found literally almost nothing written on this subject. Well, unless you count references to "sex addiction."  Addiction, really?  That's apparently a tell-tale marker for chronic PTSD.  Ahhh...but thankfully "sex addiction" isn't all that firm a professional diagnosis.  What seems like addiction to one, seems like the actual engine of life, to another.  And fortunately we're able here to consider both perspectives as we talk about it.

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Here's one of the best items we've found in the literature, and it's from Aphrodite Matsakis, Ph.D.'s book, Vietnam Wives.  It talks about sex for the veteran with PTSD as "the total stroke."  Here goes:

"On one level, this intense need for sex [on the part of the combat veteran] can be related to the veteran's loneliness. Socially isolated people are often lonely. Although they may desire to be separate, their isolation often results in their becoming "stroke deprived" -- they do not receive the smiles, the hugs, the compliments, or any of the visual, verbal, or physical recognitions (strokes), large or small, which naturally come about when with supportive others. In this state of deprivation, the vet may turn to sex to meet his social and relationship needs. Sex becomes a substitute for in-depth emotional communication, or even casual socialization.

One vet called sex the 'total stroke.' For a long time, he believed that sex would satisfy all his hungers -- his hunger for sex, as well as his hunger for human companionship and intimacy. Like many persons, he confused sex with love and emotional closeness. When sexual activity without communication left him unsatisfied, he increased his sexual activity. Even after more sex, however, he still felt restless and empty inside. Eventually he found that some communication with his sexual partner and more time spent socializing with others, not more "pure sex," helped satisfy him.

On another level, the vet's need for sex can be intense because, biologically, sexuality is "the antithesis of anxiety." As has been repeatedly proven in studies of both men and women, anxiety interferes with sexual performance, especially with orgasm. Conversely, it is difficult, if not impossible to be anxious while highly sexually aroused. Hence, for some vets, sex is more than sex. It is a form of tranquilizer or sedative for their anxieties and other tensions. Not only does sex provide a sense of physical peace, but an emotional peace as well...in this sense, sex can be used like a mood-altering drug."

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Says Jonathan Shay, M.D., Ph.D., in his book, Achilles in Vietnam:

"The overwhelming majority of combat veterans whom I have known are painfully aware of the absence of intimacy, tenderness, light playfulness, or easy mutuality in their sex lives. For many, sex is as sure a trigger of intrusive recollection and emotion from Vietnam as the sound of explosions or the smell of a corpse. Sex and anger are so intertwined that they often cannot conceive of tender, uncoerced sex that is free of rage. When successful treatment reduces their rage, they sometimes report that they have to completely relearn (or learn for the first time) the pleasures of sex with intimacy and playfulness."

(To be continued...)

Military Sexual Trauma: A Sexual Violence That Injures the Soul

The other day a reader wrote to comment on her own experience of military sexual trauma:

"From my sorry experience, military sexual assault is a predatory crime of opportunity. ...  Victims are quite disposable... few perps are ever tried in court.  Yet the victim gets quickly processed out as a defective nuisance.  You suddenly become jobless & homeless for daring to report, no matter how good your daily job performance. The victim is subhuman and utterly alone and reviled, while the predator gets a promotion.  This is probably why military rape creates more PTSD cases percentage-wise than does combat.  In combat at least you are scooped up into the bosom of your band of brothers." 

"A couple of military stats," she continues: "Sexual assault is more likely in a command that encourages/allows harassing/misogynist behavior," and "Fifty percent of perps have a prior history of violence upon entering the military -again OPPORTUNITY to observe and select their prey in close confines."  Yikes.  True? Not true?  Either way, it's a hideous experience for the unwilling victim.

That brought to mind some healing words of Britta Reque-Dragicevic, but first, the bracing truth: "Military sexual trauma is a crime, not a misfortune of war," writes Reque-Dragicevic in her book, Close to Home: A Soldier's Guide to Returning from War.  The e-book is available here for the very affordable price of $10.  Buy it :-)  Because it's a download, you can have it within minutes.The following is Reque-Dragicevic's thoughts on sexual trauma in war. 

As with the rest of her very worthwhile book, they are soothing, sane and reasonable, and will comfort the afflicted.  This book should be a must for veterans and their families; and at its very reasonable price would also make a thoughtful "Welcome Home, Veteran!" gift for veterans in your life or in your community.  She writes:

An increasingly common trauma far less talked [than PTSD] about is military sexual trauma—which is experiencing sexual assault or harassment while you are in the military. This is not just a women’s problem. In fact, the VA reports that fifty-five percent of women and thirty-eight percent of men in the military have experienced military sexual harassment. While military sexual trauma is more common in women, over half of all veterans with military sexual trauma are men.

War has historically seen an increase in sexual assault and rape incidents for both military and war-zone populations. It’s become more publicly recognized in war-zone civilian populations (mass gang rapes were widely reported during the Bosnian war and rape has traditionally been a way to violate an enemy population), but rarely do we hear about sexual assault among our own soldiers.

If you have experienced a sexual violation during war that has left you ‘just not feeling the same’ since, please know that you are not alone. Most victims of military sexual trauma will never report it. Whether or not you call it rape doesn’t matter. What happened to you wasn’t right and it wasn’t your fault; and no, you couldn’t have prevented or stopped it. Rape is always an issue of power, not sex. Unfortunately, rape in war happens too often as people deal with overwhelming feelings of god-like power, lowered inhibitions, excessive anger, lack of usual sexual release and the devaluation of human life—sexual force is often used with little outward consequence to the perpetrator. But the consequences to the victim are life-changing.

If this has happened to you, you may develop PTSD from this alone, but be too embarrassed or humiliated to tell anyone why. This may be the hardest part of your war experience to deal with and one that strangles you in secrecy, shame, and embarrassment. After all, with fellow survivors coming back with missing limbs and mental shock, how can having been sexually violated compare to that? No one would believe you, would they? What would loved ones think? Soldiers are supposed to be tough; how could you ever admit that you weren’t strong enough to keep someone from forcing sex on you? Yet, for you, what happened has become your war. A war that no one will ever know anything about.

Please stop. Stop and take a deep breath. Forget the fact that it was a war environment for a moment and realize that no matter where it happens, when, or to whom, being sexually violated always leaves a person feeling powerless, doubtful of themselves, uncertain, unable to believe it really happened, and feeling very, very small inside. Why? Because sexual assault is about taking away your power. Sex is our most intimate and most powerful interaction with another human being. And when someone overpowers us physically and enters our bodies without our consent, we are deeply ashamed and shocked at how powerless we were.

Sexual violence injures the soul. The shame, humiliation, loss of control, and shaken self-esteem affect both men and women even though each gender experiences them differently because of what we are conditioned to believe about our masculine or feminine roles in life.

Sexual violation impacts our self-image, sexuality, and our future, safe sexual experiences. The overwhelming sense of vulnerability and shame can lead to suicidal thoughts and actions.

For war survivors who have been violated by one of their own, the confusion and uncertainty, not to mention potential repercussions to your military career or even survival, lead most victims to never tell anyone. Keeping your mouth shut may be the only way to survive and get back home. But once you are home, please realize that if this has happened to you, you have been affected and it’s not just going to go away. It takes feeling safe to get yourself to the point where you can admit to someone that it happened. And for a lot of people, finding someone safe seems almost impossible.

Even if you tell no one else in your life, please call the National Sexual Assault Hotline at 1-800-656-4673 or visit them online for an anonymous chat at www.rainn.org. You can remain anonymous, and at least you will be able to talk with someone who deals with this trauma every day and can start to give you the resources you need to find healing. The VA also reports that it has counselors at every hospital trained to assist veterans with this issue. You can also visit www.ncptsd.va.gov, search for “military sexual trauma”—and a number of fact sheets will come up where you can learn additional information.

Remember, what happened to you was a crime, not just a misfortune of war. The person who assaulted you did not have the right to do this to you under any circumstances.

One of the hardest parts about having been sexually traumatized can be sharing that information with a spouse or partner. It’s normal to worry about how they will accept you once they know what has happened and to wonder how it will impact your intimate life together. Even though this trauma may loom large before your eyes, your partner loves you for who you are—not just your ability to have sex. You may find far more love and acceptance than you imagine. You are still attractive, beautiful, desirable, virile, and your partner still longs to experience sexual intimacy with you. You may struggle with feeling that you are not worth loving which is one of the ways sexual violation diminishes your own sense of power. But feelings are not facts. You are a human being worth being loved, enjoyed, and you deserve to experience sexual intimacy in a safe and caring relationship.

Partners of sexual assault survivors may feel a sense of rage, powerlessness, guilt for not having been able to protect your loved one, and a natural reaction to want to get even with the person who has hurt the person you love. Counseling individually and as a couple can be a safe place to express what you are feeling. You can also call the Sexual Assault Hotline—it’s not just for survivors; they can assist family and friends.

Remember, as long as you don’t tell your partner what happened, he or she will have no way of knowing what you are feeling, worried about, remembering, or associating with your current sex life. You may have no desire to have sex because of the trauma, but how will your partner know that? If you don’t share, he or she may assume that they are no longer desirable and that you’ve lost interest. They may easily blame themselves or you. Don’t lose your relationship because you are too ashamed to share what happened. Seek a counselor who can help you decide how to share this information. Don’t shut out what may be the only true source of love and support in your life. Loving partners can be incredibly patient when it comes to sex and trauma, but you have to give them the chance to understand what you are going through.

If you have been sexually traumatized, it may seem that that experience now defines who you are. Shame, guilt, self-blame, denial, rage, depression, lack of self-worth, fear of being intimate again, aversion to being touched or approached without warning, doubts about whether or not you are still desirable, or if having been raped effects your sexual orientation (it doesn’t) are all normal reactions. Just remember the trauma is real and intimate, but you are not defined by what has happened to you. You are a whole person who has experienced vulnerability and powerlessness; but that experience did not change who you really are: still strong, still powerful, still in control and still able to move toward healing. Deciding to move toward healing may be the only justice you ever get for what happened. You owe it to yourself, your partner, and your children to make sure that this trauma does not take you away from them any more than it already has.

Talk to a counselor. Sexual trauma is humiliating, but counselors deal with it everyday. Nothing bad will happen to you by just talking. It doesn’t mean you have to take legal action or that everyone will find out. You are not alone. Don’t let the one who took your power from you keep it.

You deserve a lifetime of being sexually loved and enjoyed.

Reprinted with permission from Close to Home: A Soldier's Guide to Returning from War, by Britta Reque-Dragicevic.  The e-book is available here for the very affordable price of $10.  Buy it :-) 

Coming Out of the Darkness, One Step at a Time

I was having a conversation recently with one of my favorite veterans (and which veteran is not?!) about how we were going to take a look at his past in a way that wouldn't also cause him some sort of setback, which I wouldn't want (and nor would he).  I'd done a little digging on his behalf, and found a bunch of "the missing link" type information about what happened to his platoon that he served with in Vietnam, during a particularly vicious battle which had left very few of his buddies alive. 

 He was away from the field at the time, recuperating at a naval hospital in the U.S., and his finding out casually about the entire wiping out of his company of Marines has been the single hardest episode of his life.  What with one thing and another, I'd managed to find out much of the information he wanted to know, but was loath to share it with him, lest it cause him any more horror than it already had.  So I wanted to proceed gingerly with him, not just set him on the slippery banana peel of reflection, as it were, and give him a push.  Vietnam had already been plenty hard for him to process, and its explosive tentacles reached all the way into his present.

We discussed the methods back and forth for a while, of what would be comfortable to share with him, and what the pace could be, and then I asked him, was there anything "good" for himself that he could be doing, so that the material might be absorbed in as successful a way as possible? Was there any special place he could go to, music he could listen to, anything therapeutic he knew to do for himself, while he tried to take in bits and pieces of information about the most troubling time in his life, that has plagued him for the 40 years since it happened.  This is what he wrote back in response:

So, what I need is a very sunny mildly cool day, no monsoon weather or rice-paddy heat; a quiet place in the woods (back forty) with my three dogs; and a print off of the material to read, meditate on, cry, scream, cuss, and read some more; AND my cell phone with your number on speed dial.  That arm and hand reaching down to pull me up out of the darkness. 

 

You know when you save someone’s life, you own that life, until they save yours.  So if you save me, you own me…

(Can you tell why I just adore him?!)  But it did also put me in mind of one other "therapeutic" item we haven't talked about much on the blog yet, but which I know about from my previous writing life.  There's a former cancer nurse named Valerie Cooksley, who's written a number of books for Prentice Hall and others on aromatherapy, but from the scientific end of things, not the frou-frou end.  For a while she was a consultant to Tacoma General Hospital, among others, and their ICU, and she developed some essential oil blends (her term) or "potions" (mine), that have therapeutic aspects.  The ones I'm remembering, because they were directed to the dying and their families, were blends that attempted to enhance people's ability to both grieve the past, and to let it go.  Somehow I can't help thinking that essential oil blends like that would be of some potential value here, too.

It would be hard to quickly go into why and how medicinal aromatherapy works -- it has greater credibilty in Europe, where Cooksley's trainers were trained -- but the concept, in a nutshell, is that essential oils have properties that can modulate people's emotional states, and they're very effective "drug delivery" models, because they quickly cross the "blood-brain barrier" through the nose, directly into the brain's mood receptor sites. I've probably just botched the science by trying to explain it in two sentences and get back to the point, but that's the gist of things, and Cooksley knows what she's talking about.

If you're a fan of the Bible, you also remember essential oils in use with the "We Three Kings of Orient Are" types, who allegedly came to visit Jesus.  "Anointing people with oil" is a practice that dates back at least to Biblical times.  "Gold, frankincense and myrrh" were the three gifts the Wise Men brought (why do they sound like Mobsters, at this remove? Too much "Sopranos") -- and of those, two were rare, costly essential oils.

Just to be very clear on this, I by no means think that dabbing or sniffing a few essential oils is going to be a cure for PTSD.  However, as a pleasant adjunct to what you're already doing, or a lovely relax-i-fier that can be put into use at any time?  Great stuff, and a nice addition to life, in the way that a massage is, or great sex -- not curative in itself, but a nice and pleasant and stress-reducing aspect to life, that's wise to incorporate into your life as much as possible.

Herewith some lovely blends of Cooksley's, along with her notes as to why those particular choices.  Although she's focusing on "death and dying," expand the definition of that as you read these blends to include situations that would also bring up horrifically charged emotions around that topic, such as revisiting combat trauma, and those who were dead and dying there, plus the resultant grief, shame, guilt and confusion that typically surround these episodes.  (This may explain why my "lavender sleep pillows" for returning combat vets and their families, made from a Cooksley recipe, and blogged about here, were consistently such a big hit.)  The last two she mentions are the two I would particularly want to focus on.  You'd have to "read the directions" elsewhere on how to use essential oils (externally, obviously), but sometimes even a drop touched to the underside of your nose, at the point where it meets your upper lip, or waved underneath on a tissue, can give you an immediate "read" on whether the remedy might have some value for you. 

It's also fair to say that anyone I've ever made essential oil blends for, after Cooksley's recipes, has become a fan for life: they're "delish," and this is just lovely high-touch, low-tech stuff.  Women tend to be bigger fans than men -- they're six times as able to "notice" the scents themselves, though this isn't necessary for the scents to do their work -- but both sexes have been able to see the value, once they've tried a few of these for themselves.

“Serenity Blend”: Lavender 15 drops, Bergamot 6 drops, Mandarin 3 drops.

“Anti-depression”:  For depression or grief; useful for back or hand massage. 

Lavender 9 drops, Ylang-ylang 9 drops, Basil 2 drops, Geranium 2 drops, Bergamot 2 drops.

“Joyful Hope”:  Anti-depressant blend.  Uplifting and purifying, to encourage a healing and caring environment.  Orange 4 parts, Ylang-ylang 2 parts, Bergamot 1 part, and Lemon, 1 part.

“Grief and Bereavement”:  For dying patients and their families.  Lavender 4 parts, Marjoram 1 part, Hyssop 1 part.

“Ceremonial Oil”: A nurturing, peaceful blend, to be used with terminal patients.  Helps with feelings of fear, encourages faith.  Grounding hand or foot massage, solar plexus, or used to anoint head.  Lavender 10 drops, Ylang-ylang 8 drops, Sandalwood 4 drops, Frankincense 2 drops.

Another book on the suitably "grand and broad" topic of Aromatherapy and Healing the Spirit, mentions this blend for helping soothe "sudden psychological trauma" -- perhaps, in this case, as it is revisited in memory:

Lavender 3 drops, Frankincense 2 drops, Spikenard 1 drop.

And there's also an item that has a long therapeutic history in Complementary and Alternative Medicine, a blend of Bach flower essences called "Rescue Remedy," available, like essential oils, both online from Amazon.com and places like Whole Foods, Wild Oats, and other natural grocery stores.  Rescue Remedy is a low-tech, non-drug remedy for calming nerves that has an enthusiastic following among a diverse group of CAM adherents, including veterinarians. (I highly doubt even the skeptics suggest that animals are susceptible to the Placebo Response ;-).

 

I wonder if we can add one of these to the list of what my friend will be taking into the woods with him, when he wants to try processing his trauma from the past, in manageable bits and pieces; I hope so.

 

I'd actually like to see him outfitted with many of these items, some soothing, restful music, and Thomas Day Oates, Jr.'s spectacularly-soothing DVD, "Pacific Light," which we blogged about earlier, here.  Maybe he'll need a little red wagon, too -- to carry all that stuff into his healing space into the "back forty" of the woods, with the dogs running along beside him, hoping for the best.

 

In a perfect world -- ahh, I can dream, can't I? -- veterans healthcare options for PTSD would include scented oil massages with just the essential oils necessary for helping speed healing, or take the edges off the particularly hard memories.  As no less an authority on health than Hippocrates, the father of Western medicine, once said:

 

"The way to health is to have an aromatic bath, and scented massage every day...healing is a matter of time, but is sometimes also a matter of opportunity." -- Hippocrates, father of Western Medicine (460-377 BCE)

 

Here's hoping that my adored veteran buddy gets his healing, and his opportunity...

Editor's note: Update...he certainly seems to have. Read the "before and after" of his story, here.

When the Sexual Predator Wears a Uniform: Athletes, Warriors, Women and MST

Editor's Note: This lengthy passage, excerpted with permission of the author, is linked to the previous blog post, "Unchecked Aggression: Women Servicemembers, Contractors and Military Sexual Trauma," linked here.  Read that first to get a sense of why this passage is being introduced.

 

The author introduces the problem that a few athletes (like a few servicembers) are sexually predatory, in a subculture that rewards aggression.  He writes, in the chapter called "When Women Are the Opponent":

Despite the ever-increasing number of sexual assaults and domestic beatings reported to police annually the mainstream press affords little attention to such crimes.  One exception occurs when a prominent individual, particularly an athlete, an unique blend of role model and celebrity, is linked to such an incident.   The increasing frequency of accusations of abuse against sports figures has stirred unprecedented interest in a pervasive social problem that for decades has stirred little.  Although the widespread mistreatment of women clearly transcends the playing field, the attention and popularity enjoyed by sports figures has brought the sports culture under intense scrutiny by researchers looking for links between competitive team sports and the violence that occurs away from the field.  As a result, a perception is growing that the aggressive nature and competitive atmosphere of male athletics can lead to criminal aggression against women.

 

Although the attitudes associated with male sports can reinforce sexist attitudes towards women, the suggestion that sexism is the dominant influence behind the rash of violence by athletes against women both overstates and oversimplifies the relationship.  Participation in athletics does not cause men to abuse women, but it can help to incite transgression in those athletes who are predisposed to such acts.  And certainly the culture of male athletics (using sexist locker room dialogue; rewarding aggressiveness, legitimizing violence) helps to sustain negative attitudes towards women.

 

….

 

“A stronger link between male athletes [sexual predator  servicemembers] and the criminal abuse of women is the socialization process that takes place away from the playing field…”

 

“Operating under an increased sense of power [armed combat] and the mantle of public trust [patriotism, and the unwillingness to question what goes on when we’re fighting a war], athletes [servicemembers] inclined to sexual and physical violence have ample opportunity to exploit women who often misperceive them as respectable citizens [fellow servicemembers; sometimes their superiors].

 

“Among men who harbor violent tendencies toward women, athletic success may accelerate the exhibition of abusive attitudes, increasing the frequency of violent incidents.  Nonetheless, that is less a function of athletics per se than a reflection of the modern athlete’s [warrior’s] status as an icon of pop culture.”

 

…

 

But an occupation that thrives on a unique capacity for aggression among participants runs the risk of being a home for troubled men who cannot contain their rage against the opposite sex.  Because of the physical nature of athletics [combat]; the aggressive, confrontational, super-macho attitudes surrounding them; and the social approval afforded to celebrity-athletes, the sports industry has in effect embraced those men who demonstrate a disdain for women through repeated acts of criminal violence.”

The author then introduces the example of Cincinnati Bengals and Green Bay Packers cornerback Lewis Billup:

“Although he took advantage of his exceptional access to women, Billup’s desire to control them had little to do with his athleticism.  Rather, a much more complex set of factors was contributing to his routine violence.  “It has to do with power and control and hate…a disdain for women,” said Victoria Vreeland, co-counsel for Victoria Alexander, who sued Billup for rape. 

 

As the former president of King County Rape Relief in Seattle, and an assistant to Washington’s Attorney General in drafting the state’s Victim’s Rights Bill, Vreeland was quite familiar with the mentality of men who acted like Billup. “The person [the victim of abuse] isn’t a person anymore, they’re an object.  To that extent, if you  have some societal sense or your grew up with a lack of power or control, or that you weren’t as good, this offers power and control.  “I wanna be in charge.” 

 

It is similar to children who lack a sense of power.  Their feeling of powerlessness somehow gets twisted around in their minds and so the way to be powerful is to pick on somebody else.  If you grow up with crime and objectification, making people objects, then killing them or harming them doesn’t matter.  They are not human.”

---

Then he discusses Mike Tyson's problems with women in depth, writing:

“Greg Garrison, the special prosecutor who successfully prosecuted Mike Tyson for raping [18 year old Desiree] Washington, concluded that Tyson’s violent tendencies toward women, like those of many other abusive athletes, were exacerbated by his sports career.

 

“Professional athletics has become such a megagod that it is sometimes unresponsive to the morals of a community,” said Garrison.  “Sometimes it just doesn’t matter what a superstar does, it’s OK.”  This is a particularly dangerous scenario when men who are prone to violently abuse women get involved and are thrust into an environment where their contact with women increases.”

---

“Professional sports leagues and individual teams are in a more influential position to discipline and deter players from this type of behavior, yet they often decline to do so.  Off-the-field criminal violence is repeatedly tolerated as long as players perform on the field.  Clearly … countless male athletes live and work in a similar environment without ever engaging in criminal mistreatment of women.  Nonetheless, the fact that predators … are playing professional sports demonstrates the degree of indifference exhibited by owners, managers and coaches.”

 

“As in most case of abuse against women, the majority of women who are assaulted by athletes are their acquaintances.  Those few players who are inclined to violate women enjoy almost  limitless opportunity to meet, and ultimately victimize, women.”

 

“Athletes use their celebrity as their billyclub to gain the superior position [with women],” Garrison said.  “Tyson knows he forced Desiree, but he doesn’t care, because that’s what he does.”

 

“One NFL player who has seen the way Tyson interacts with women supported Garrison’s position.  “You can’t imagine,” said the player, on condition of anonymity.  “I’ve been to social functions with him.  He walks in there and goes, “I’ve got to get some pussy, got to get some pussy.”

 

“Now I’ve been around a lot of people, but nobody comes in there with the proudness that they’re that macho that they can just …  It’s like a drink, an item, there’s no feeling behind it.  It’s just something that he’s got to physically conquer.  He’s a product of his environment.”

 

Tyson developed a proclivity toward the abuse of women at a young age – a habit that mushroomed with his rise as a boxer.  As a child he witnessed numerous incidents of violent abuse inflicted on his mother by boyfriends.  As a young teen, demonstrated a disdain for young girls who repeatedly made fun of his high voice and chubby fame.  After the renowned boxing trainer Cus D’Amato rescued Tyson from a life of violent street crime, handlers honed Tyson’s exceptional strength and fury into a relentless fighting machine.  They used his distrust and anger toward others to motivate him and elicit his aggression in the ring.

 

D’Amato once presented Tyson with a baseball bat, prompting Tyson to ask, “What’s this for?”

 

“For the women,” the trainer explained, “When you’re the champion, you’re going to need something to beat them off you.”  Although tactics such as this were designed to strengthen Tyson’s damaged ego, the message they conveyed bolstered an already dangerous attitude toward women.

 

A champion before his twentieth birthday, Tyson indulged in countless sexual liaisons with women.  Yet, his contempt for them only increased.  He confessed to fellow fighter, Jose Torres.  “You know something, I like to hurt women when I make love.  I like to hear them scream with pain, to see them bleed.  It gives me pleasure.”

 

“Well, did it ever occur to you that men who behave that way probably hate women, that deep down they simply don’t like them?” responded Torres.

 

“You may be right,” said Tyson.  “You’re the first person to tell me that.  You know, you may be [expletive] right.”

 

Bitterly aware that women’s interest in him was based solely on his high profile, Tyson nevertheless used that profile to his advantage in his quest to obtain sexual gratification and domination over women.  Through repeated encounters with multiple women, often prostitutes or so-called groupies, Tyson developed an insatiable appetite for sex. …

 

Garrison saw Tyson’s training as a boxer as a lethal trigger mechanism that unleashed his disdain for women. When his sexual advances met with resistance, Tyson approached the unwilling woman much as he would an opponent in the ring. “The wife of every lawyer says, ‘Don’t get into an argument with them [their husbands], because they do it for a living.  You may be right, but you’ll never win,” Garrison said.

 

“What about a boxer?  Boxers are masters of physical deception; at moving in one direction, but actually moving in another; at feigning left and going right; at appearing to be at a disadvantage when in fact they are poised to strike when somebody sees and is sucked into the apparent deception.  Boxing is lying for a living.  You don’t not be a boxer when you leave the ring.  What I wanted to do was to show the jury that this guy will deceive because he’s good at it.”

More on the Tyson assault and ability to accompolish same:

 

“The cordial small talk he had made at the Expo and in the limousine soon turned to sexually suggestive dialogue.  The abrupt change in Tyson’s manner left Washington totally unprepared for what was to follow.  “Desire struggled real hard with, “How could he be like that? He’s Mike Tyson.  My dad idolizes him,” said Garrison.

 

When Washington showed no interest in his sexual advances and tried to flee, Tyson quickly moved to snatch off her clothes and overpowered her with brute force.  Despite her pleas that he stop, Washington became the object of Tyson’s unchecked sexual desires.  “[Tyson’s training as an athlete] certainly plays a role when you realize that any [professional] athlete is possessed of such incredible physical gifts,” said Garrison.  “Guys that get cut from [pro teams] are physical geniuses by comparison to the man on the street. And the players at the top of their profession?  Could O.J. Simpson kill two people with the same knife?  Of course he could, and neither one ever even know what hit them.  You watched him run.  How many guys did you see tackling air?  Laundry was all over the field.  And these men are as good as him.  He was quick as smoke.  Tyson’s the same way.  He looks like he’s going someplace else and bam!  You’re gone.”

Then the author concludes:

A subtle but important distinction is that athletics did not train Tyson to be a rapist; rather, his athletic training became a dangerous weapon in his misguided conception of what qualified as appropriate treatment of women.

“If I want it, I get it,” is the mentality that they’ve trained him to believe,” said Garrison.  “If I want to knock you out, then you’re going to be knocked out.”  Unfortunately, it’s persuasive in many of the wrong directions.  The reason that Mike Tyson won’t admit rape is not because he didn’t do it or because he didn’t think he did it, but because he didn’t think there was anything wrong with it.”

 

The disparaging attitudes toward women held by Billups and Tyson are consistent with those of the small number of athletes who are repeatedly associated with allegations of rape and battery.  While there is no shortage of men who commit crimes of violence against women, few rapists and batterers combine exceptional physical superiority and with an aura of public trust, as deviant athletes do.  Within the confines of the revenue-producing sports, men who are inclined to abuse women are left to inflict their abuse without punishment or the stigma usually attached to sex crimes and domestic battery.”

-- Excerpted with permission of the author, from Public Heroes, Private Felons: Athletes and crimes against women,” by Jeff Benedict.  Boston: Northeastern University Press (1997).

Unchecked Aggression: Women Servicemembers, Contractors and Military Sexual Trauma

The local news today showed another woman servicemember, 34, dead in Iraq of a non-combat wound.  Just days away from a planned, 18 day leave back to the States, she's no longer going home to see her devastated family - or anyone else, for that matter.  The investigation into her unexpected death is still pending, but really -- how many people die accidentally, or worse, kill themselves just before they're liable to get out of hell?  It's a little...ironic, if not completely counter-intuitive (that's, the complete opposite of what you'd normally think, for the non-academic types out there reading this.) It's also particularly tragic, and all the more so if something like military sexual trauma is involved in her death: it has been in a number of others.

---

While I haven't done a count lately of how many women have been dying non-combat deaths in Iraq or Afghanistan, however high or low the number happens to be, a percentage of those deaths will turn out to be murders that are botched or intentional attempts to cover up sexual assault; and another percentage will turn out to be suicides by women who have been sexually assaulted or raped, whether by peers or superiors.  In the "bubble" of living and working for the military, whether as a servicemember or a contractor - women place themselves in an environment where men are the majority, where calculated, strategic violence is the goal (we call that, "combat"), aggression (directed toward the enemy) is the norm, weapons are ubiquitous, and boredom, opportunity, and mixed feelings about being there in the first place create an explosive brew.  Just like KIA versus WIA statistics, for every woman killed or suicided, many more are injured and sexually exploited.

That's the bad news -- but it has to be balanced against the fact that these crimes, and the predators who commit them, are the minority.  Many women pass through the military without becoming victims of sexual harassment or predation; but for those who do, it's often a life and psyche-destroying event.

---

Paul Reickhoff wrote about military sexual trauma today and women in the military in an excellent post, published on the IAVA Blog, linked here.  According to statistics he cites, "Women make up 20% of all new recruits and more than 11% of the forces deployed to Iraq and Afghanistan."  Then he tellingly adds:

"The rates of assault are shocking.  Almost one-third of women veterans say they were sexually assaulted while in the military. (In the general population, one out of every six American women has been a victim of a sexual assault.)  Already, 15 percent of female Iraq and Afghanistan veterans who have gone to the VA for care have screened positive for Military Sexual Trauma.  But even these troubling figures may not be telling the whole story; experts estimate that half of all sexual assaults go unreported..."

All too true.  We've written about Military Sexual Trauma (MST) before on this blog, several times.  It's a hot topic right now, not the least because there just aren't many answers out there about what to do for women who have been affected by it.  What we do know is that it's a potent terror: women who are victims of MST often develop PTSD, the frequent theme of this blog -- and of those who do, the MST is often considered worse than even their usually concomitant PTSD.  Yikes.  That gives you an idea of how horrific the experience is for these tough, trained, formidable and admirable warrior women.

I can also tell from who's searching this blog for answers, and what they're looking for, that there's not much out there that specifically addresses the needs of women veterans who have been sexually traumatized by other servicemembers.  Fortunately, there are a few programs at the VA that are attempting to address this problem, but sometimes I see them searching here, too, for answers.  The answers that would help put these women's broken lives back together may simply be lacking, at present.

In lieu of "answers," what I'd like to offer here is another way of looking at the same problem.  With the permission of Jeff Benedict, I'd like to quote at length from a chapter in his book, "Public Heroes, Private Felons: Athletes and Crimes Against Women," published in 1997 by Northeastern University Press (Boston, Massachusetts).  Benedict, a longtime journalist, is now an attorney in private practice in Connecticut. The chapter is called "When Women Are the Opponent."  As you read the lengthy excerpt from this chapter, try to absorb the great similarities (not perfect as an analogy, but as close as we're gonna get, for the present) between two arenas in which men are systematically trained and rewarded for aggression. 

As Benedict repeatedly points out, and I will have to add as an obvious caveat too, the majority of men who are involved in either pursuit -- professional sports or the military -- can behave appropriately towards women in their midst.  The problem is not with the majority; it's with the minority, who for one reason or another cannot. 

As you read this passage, I've highlighted what I find the biggest issues to be.  Every time Benedict mentions, "athlete" think "warrior" instead, and see if the analogy doesn't work.  Again, we're not talking about MOST men who are in this situation; we're talking about the minority who are the problem.  But the problems these few create are so horrifically soul-destroying to the women who experience them, whether servicemembers or contractors, that much more needs to be done on the part of those who watch over women in the military, to protect them from predation from the few who seek to harm.  The consequences to the women who are affected's lives and psyches are just too great to ignore or overlook or neglect any further.  It's definitely a case where "prevention" of this type of suffering is far more effective than a nebulous "cure" that seems sadly, at this hour, out of reach.

Editor's Note: Given the length of the excerpt, I'll go ahead and create it as a separate blog post, linked here.

Shaking Off the Blues: Two New Books Help Veterans and Others Get "Unstuck"

A well-regarded psychiatrist who thinks there are other-than-pharmaceutical antidotes to biochemical depression?  Rank heresy!  Oops, actually we meant -- how very refreshing indeed. 

A soulful journalist who's lived and worked in war-torn countries, and knows what it's like to be a survivor -- who then turns her attention to helping veterans and their families come home from war and rebuild the pieces of their often-shattered psyches? Again, a wonderful suggestion.

---

NPR the other day published a great interview with none other than James S. Gordon, M.D., author of the new book called "Unstuck: Your Guide to the Seven-Stage Journey Out of Depression." Depression is an important topic, because many people who are risk for suicide have depression as an underlying state.  According to one psychiatry textbook for medical students, "A majority (60% to 80%) of people who commit suicide carry a diagnosis of depression."   

If you remember, we've talked about Dr. Gordon on this blog before.  He has an impressive, very talented background academically (Harvard College, Harvard Medical School), and is the founder of the Center for Mind-Body Medicine in Washington, D.C., as well as a frequent lecturer at the Smithsonian, and the former chairman of the White House Commission on Complementary and Alternative Medicine, also known as "CAM."  (We've blogged about CAM, also known somewhat misinformedly as natural medicine, and its opportunities for treating PTSD here on the blog, at length here; and also about the varieties of mind-body medicinethat might show some promise for treating combat trauma and PTSD, here.)

To listen to the NPR interview, or to read the accompany material on getting unstuck -- in Dr. Gordon's words -- click here.  To read Dr. Gordon's bio -- click here.  To read our previous posts about his work on "Healing the Wounds of War," click here; on "Healing the Troops," click here; and on his and the Center for Mind-Body Medicine's annual conference, planned for October 25-29th in Minneapolis, Minnesota this year, click here.  The topic of this year's conference is the highly-appropriate "Integrating Mind-Body Medicine into Clinical Practice, Medical Education & Trauma Healing."  As Dr. Gordon's website says, "We're teaching thousands to heal the world's millions." Indeed -- and what a noble task that is; and how very, very vital.

If I had ONE RECOMMENDATIONfor the Pentagon, the DOD, the VA, the various branches of the military (Army, Air Force, Navy, Marines, National Guard) that frequently comb this site, looking for answers to the questions they have -- it's that they would get to know Dr. Gordon's work, and send representatives to this conference in late October, 2008.  Check into mind-body medicine, with a credible expert, and somehow who's already worked with, and proven his work with, the war-torn and traumatized (troops and civilians) here and abroad.  Broaden the outlook on how to treat PTSD and combat trauma, by returning people to themselves, and helping them to learn to manage their own stress in creative and supportive ways.

Dr. Gordon says his book, Unstuck, goes into many of the same principles that his trauma work does. I can't wait to start reading my copy, which his office promises to send.

---

In the meantime, I hope Dr. Gordon gets to cross paths professionally with Minnesotan Britta Reque-Dragicevic. I have read her book-- devoured it in one sitting is the more accurate description -- and think it has lots of potential to comfort, support and nurture returning veterans and their families in putting the pieces of the puzzle back together.  (One thing I love about both Dr. Gordon and Britta Reque-Dragicevic -- they both "get" it.  They've had a personal experience with what they're talking about; it's not just academic.  And they're both driven to help others heal from their suffering -- the not exactly unspoken single purpose of this blog: there's synchronicity.)

Reque-Dragicevic has written a completely soulful manual on getting unstuck herself, and with her profound understanding of the needs of trauma survivors, as a longtime journalist in post-war Saravejo and Bosnia, I sense a little (**magical?!**) professional matchmaking going on that would only serve to increase the amount of healing and overcoming in the world, especially among trauma survivors and veterans with PTSD.  If you want to read more about Reque-Dragicevic's marvelous book, Close to Home: A Soldier's Guide to Returning from War, click here.  Her book is endorsed and recommended by Dr. Edward Tick, among others.  At a mere $10 as a download on the Web, you really can't go wrong.  (We'll be quoting from Reque-Dragicevic's book on this blog in the future, with her permission, because it's wonderful stuff and she really "gets" it. Veterans and their families need to experience this.)

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If you have $10 to spare, or as a gift for someone else, buy Britta Reque-Dragecivic's book.  It's a download, and you can have it in your hands within minutes, from anywhere in the world, and start the healing process today.  If you have about $18 and shipping, buy Dr. Gordon's book, and start the healing process when it arrives in the mail -- or at your local bookstore.  If you have about $40, buy them both :-)

Moving Violations, or the Needle in the Red Zone - Combat Veterans and Adrenaline Addiction

Adrenaline in combat helps the servicemember stay alive, and execute the plan.  Being addicted to the same adrenaline rushes after combat, though -- back on the home front -- can go from being an asset to a liability -- especially behind the wheel or on the motorcycle, and contributes to the sad phenomenon known as "non-combat deaths" from various origins.

Enough returning combat veterans kill themselves through reckless driving that different steps are being taken to warn participants of the semi-obvious dangers:

The Guardian (UK) newspaper has a story in today's paper, previously published yesterday in the Observer (UK), about the the British military's current advertising campaign to warn returned servicemembers about the dangers of amped-up, reckless driving.  The article, "Ads warn soldiers back from war zones against reckless driving," is linked here.

Says the article, "British soldiers are twice as likely as civilians to die as a result of reckless driving, because they have difficulty adjusting to normal life after returning home from active duty, according to official statistics."  The ads feature catchy slogans, such as "Drive Carefully.  You're Tough, but Not Invincible," and one directed to motorcyclists, "You're An Accident Waiting to Happen."  Hmmmn.  Those ads are likely to catch people's attention -- in fact, almost 60% of troops surveyed said they would think about slowing down, said the article, after considering them.

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Rick Roger's article in the May 23 issue of the San Diego Union-Tribune talked about the rash of non-combat fatalities among Marines at Camp Pendleton, many of whom had died in motorcycle fatalities.  Five Marines had died in the past eight days, where the "confirmed or probable causes" were homicide, suicide and traffic accidents. The article described Marine commanders and commands "backtracking to see if we need to do anything different to avoid these things happening again.”

It also clarified:

“Two of these deaths were caused by apparent motorcycle accidents, an area of deep concern for our Corps as motorcycle fatalities continue to rise at an alarming rate,” the statement said. “In a recently released All-Marine Message, the commandant outlines guidance and directives designed to curb motorcycle injuries and fatalities.”

Motorcycle-related deaths in the Marine Corps have risen every year since 2004, when there were seven. Last year, there were 19, according to the Naval Safety Center.

As for efforts to minimize combat stress and substance abuse, Camp Pendleton officials said the base has programs, policies and officers devoted to outreach and education. They also said each unit conducts monthly random drug tests on a mandated percentage of its Marines."

(Since that article was published, even more Marines have died as a result of motorcycle accidents.  See the article by Trista Talton in Friday's Marine Corps Times, linked here.  She writes, "Twenty Marines have died in motorcycle wrecks since Oct. 1, making this fiscal year the deadliest on record despite the Corps’ efforts to reduce two-wheel fatalities."  YIKES.

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From an article in the May 13, 2008 edition of the Marine Corps Times:

The new order, a work in progress for about six months, was initiated because of the number of motorcycle fatalities and injuries occurring within II MEF. From October 2007 to January 2008, more II MEF Marines died in motorcycle wrecks than in combat.

According to the order, released April 29, most of those deaths involved junior Marines and included things such as reckless behavior, blatant disregard of orders and policies, lack of proper training, little driving experience, alcohol and willfully disobeying state and federal traffic laws.

Information about the order is linked here.

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"Adrenaline addiction" is a familiar concept but by no means an official diagnosis (there are, however, informal support groups for it, on the Web, although I wonder if they're not just catchy names for invitations to drag racing and hang gliding events :-).

Sgt. Chad T. Jones wrote about it, back in April of 2004, in an article called "Flipping Off the Switch Can Save Your Life," linked here, first published in a Fort Bliss military publication, called the NCO Journal.  He introduced the article by saying:

A Soldier who has recently returned from Iraq might experience a need for a combat-level rush, called adrenalin addiction. The cravings for this excitement could kill him, but a patient, informed leader can intervene to save the Soldier’s life.

This information is a little on the generic side (in other words, seems like common sense) -- but apparently it's worth thinking about for those who haven't already considered it.  (It would be interesting, too, to learn the age ranges of those surveyed, above, who thought that just seeing the ad's message would reinforce their behavior towards slowing down and being more reasonable.  My guess is those were the older survey participants, because with age comes wisdom -- or so they say -- and/or the change to experience a few close calls with reckless behavior, which also has an impact on slowing us down.

From the same 2004 article:

Adrenaline addiction is something Soldiers returning from deployment are susceptible to, and is described as the need to engage in excitement-seeking behavior, said Col. Robert Gifford (Dr.), associate professor of psychiatry, Uniformed Services University of Health Sciences.

“Soldiers, when they come back from a deployment, have often been observed engaging in ‘excitement-seeking behavior.’ It includes a lot of people who liked excitement before and
Soldiers who come back [from a deployment] and miss the excitement, and sense of purpose that comes with a deployment,” Gifford said.

Usually, Soldiers are able to adjust their lifestyle or compensate for the lower operation tempo, but unfortunately other Soldiers “can’t find adequate ways to fulfill themselves, and they become excitement junkies,” said Lt. Col. (Dr.) David M. Benedek, associate professor of psychiatry, Uniformed Services University of Health Sciences.

Specific evidence stating why a Soldier seeks danger is not existent, Gifford said. But a popular opinion among medical professionals is that Soldiers are trying to replace the constant adrenaline needed to be successful in a combat environment.

“Operational or combat environments require a sense of alertness all of the time and it is very difficult to turn that off when you return home. Even though Soldiers are glad to be home, many found features they enjoyed while deployed,” Gifford said. “Sure it’s hot and miserable, but there is a sense of purpose. Suddenly, you’re home and those senses of purpose or excitement are suddenly gone, and people may not want to give that up so quickly.”

One way emotion leads to the reckless behavior is that Soldiers feel indestructible when they get home because they survived combat. That carelessness or sense of being indestructible can be dangerous, Gifford said. “Clearly any person who gets involved with risky behavior puts themselves in a position to get hurt, or killed,” he said.

While "adrenaline addiction" or being an adrenaline "junkie" isn't a true "addiction," as defined by the experts, there are some obvious similarities, including developing cravings for the environmental stimulants that provide the adrenaline rush -- many of which were available in combat situations, but not on the home front.  It's hard for many returning servicemembers to calm down -- and this is understandable -- after the rigors and the scares of combat.

Says the article:

"Upon detection [of the problem], leaders have many options they can use to help the Soldier. “There are a variety of mental health sources,” he said, but many Soldiers feel more comfortable talking to Chaplains or someone else. The important thing is to get the problem surfaced.”  Once the problem is brought to light, it’s important to figure out why the behavior is occurring. “Reckless behavior may be a signal of a number of illnesses or situational things that might resolve itself on its own or it might take a medical professional to figure out what to do,” [Col. Robert] Gifford said."

As I'm typing this out, though, I'm reading an email from a favorite Vietnam vet, telling me about the battle for Hill 881, and saying, in part, "without masses of adrenaline rushing through us, we couldn't have done this..." Aye, there's the rub.  Sometimes it's a total asset to have it; and just as easily, it becomes a grave liability.  Context is everything.

If you remember watching the Kellee Twiggs video (SSgt. Travis Twigg's wife, speaking after his death from PTSD), you will recall her talking about how jumpy her husband was -- how he couldn't sit still long enough to watch a movie with her and the kids; that his legs were always twitching.  To a certain degree, this must be a conditioned response from combat -- all that hyper-alertness turns into just plain jumpiness, with nowhere to go.  No wonder people try to bleed it off, doing risky things -- it keeps the feedback loop primed.

Sad to say, though, it's a feature of post-deployment life that servicemembers will need to get a handle on, through any reasonable means necessary -- and with good advice from practitioners they trust -- because failing to do so will prolong their suffering, and put their safety and sometimes that of other people's at risk.  Good for the British to be doing these ads, but as the popular saying goes, you can't really regulate human behavior. Suggesting that there might be a problem, though -- may be what amounts to a start.  An attempt to get the needle back out of the red zone...

Of Vietnamese and Veterans: To "Forgive Themselves and Heal..."

A story told by Edward Tick, Ph.D., author of War and the Soul: Healing Our Nations Veterans from Post-Traumatic Stress Disorder,  in an interfaith sermon from November, 2006:

Here is a story from My Lai, a hamlet as full of loss for the Vietnamese as Ground Zero, Manhattan is for us. I met a 75 year old woman there, the lone survivor of her entire family. Her parents, husband, children were all killed in the massacre. She said that it would have been far easier to die that day than survive to carry this pain her entire life.

Grandmother,” I said. “Then how do you feel about us Americans visiting you here?” "You must come,” she said. “Everyone must know the story.”

“I understand," I said. “That is why I am here. But what about our veterans? How do you feel about them returning? They might have killed your people. They might have even been here on that day.”

“No,” she answered. “You must understand this. Often I think the only reason I survived with this pain is so that I could live to meet your veterans, take their hands, look into their eyes, forgive them and help them forgive themselves and heal.”

Source: Tick's sermon, "Stop the Hate," from which this story comes, is linked here.  His book, War and the Soul: Healing Our Nations Veterans from Post-Traumatic Stress Disorder, is linked here. To read a quick web bio of him, click 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: (That's Some) Pretty Terrible Sh*t (to Have to) Deal (With), Don't You Think?

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

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

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

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

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

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

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

 

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

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

All I wanted was someone to talk to.

 

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

 

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

 

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

 

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

 

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

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

Making an Attempt to "Strip the Fuse" - Initiating Dialogue between Local Police and Veterans

NPR has another great story today, on a few OIF/OEF (Iraq and Afghanistan) combat veterans telling their stories in a public setting, in an attempt to defuse potential conflict with the communities where they live, especially with the police.  The story is called, "Dialogue Bridges Divide between Vets and Police," reported by Libby Lewis, and you can read the story or listen to it, here. It highlights the work being done by Jay White of the Hartford, Connecticut Vet Center, a facility funded by the Department of Veterans Affairs. According to Lewis, "before becoming a counselor, White served two tours in Iraq. The dialogues he moderates are meant to connect veterans with people who have no experience with war, namely people who deal with trouble — like police and emergency rescue personnel. These are the people whom soldiers returning home often find themselves dealing with."  It's great to see necessary, proactive stuff like this.

A surprising statistic, quoted in the story, by Brian Killany, a police crisis negotiator:

"The chances of [veterans] becoming a target group for us to have to deal with as a [police] negotiator is probably better than 50-50.”

Y-I-K-E-S.  Forewarned is forearmed -- no pun intended.  So much better to prepare for this in the way this program is doing, than be surprised by it -- when it's clearly a strong possibililty.

The NPR story also highlights the work of a Connecticut-based group, "Brothers in Arms," which the program says is "run by Iraq veterans with a mission of helping other returning soldiers. They also organize public speaking events to create awareness among civilians about the struggles of war veterans."  Their information is linked here.

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In addition, although not mentioned in the story, there's a great, 10 minute long video available on YouTube, which we blogged about here, by William R. Keating and the Norfolk County (Massachusetts) District Attorney's Office.  It's called "PTSD and Veterans: Beyond the Yellow Ribbon," and part of what it addresses is the re-integration of a combat veteran into his or her community, including the possibility of conflict with the police, and how both sides can manage that.  Well worth watching and bookmarking. The blog post we did about it a year or so ago is linked here, and it includes the video.

(Other counties in Massachusetts and in other states should consider contact William Keating's office and seeing if they can use the video with their constituents.  Information useful for contacting the Norfolk County (Massachusetts) District Attorney's office is linked, here.)

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Recently, we blogged about the similarities that cops and troops share in their exposure to cumulative increments of trauma, which often result -- for either of them -- in PTSD.  Ultimately, cops and troops may find out that they may find out they have more in common than they thought -- in terms of what they've been exposed to in their lines of work -- not just wearing uniforms, working out and carrying guns to work. 

Editor's note: The Hartford, Connecticut Vet Center information is linked here.  The directory lists Jay White but provides no additional contact information for him; undoubtedly, he can be reached the Center.

NPR Local Affiliate KQED's Story about VA Being Sued over Veterans' Healthcare

According to a story aired today on KQED -- a San Francisco public radio and television station, and NPR affiliate -- Berkeley, California's Disability Rights Advocates recently filed a lawsuit "that could affect thousands of veterans returning from Iraq and Afghanistan. They allege that the Department of Veterans Affairs is unable to provide timely mental health treatment for returning veterans. It describes a backlog of 600,000 claims for vets seeking care — some dating all the way back to the Vietnam War." To listen to the approximately five minute story, click here.  (And yes, this is the lawsuit that's produced the incendiary emails that have lately been in the news, including the infamous "shhh..." one about veterans suicides, which we blogged about earlier, here.)

Editor's Note: For more information about the veterans access to healthcare lawsuit in Federal court, as provided by the Disability Rights Advocates website, click here.

Chaplain John Morris, Minnesota National Guard

Caveat gentle reader: We have no idea if Chaplain John Morris, oft-quoted chaplain of the Minnesota National Guard, is any sort of functional expert on PTSD.  What we do know is he's a straight-talking, reasonable proponent of caring for the troops, and as such, he totally has our vote of confidence.  Here's a little biographical information about him:

John Morris, an Army Reservist, has served in Norway; Kuwait; Qatar; Iraq; Cuba; Ft. Steward, Georgia; Ft. Benning, Georgia; Ft. McCoy, Wisconsin; Ft. Bragg, North Carolina; and Ft. Irwin, California. After serving as senior pastor at St. Croix Valley United Methodist Church for eight years, he was mobilized to serve with Army Special Operations Command in January 2004. In Iraq, he visited Psychological Operations teams in 17 different camps. Chaplain Major Morris is currently a full-time chaplain with the Minnesota National Guard. He is a 1986 graduate of Minnesota's Bethel Seminary.

He's frequently quoted by NPR, the Cloquet, Minn. Pine Journal, which did a fine series of articles on Minnesota's returning National Guard veterans, and the Christian Science Monitor.  We've blogged about hm in a series of posts, linked here.  He's immensely quotable, and he's a heartsy proponent of meeting the troops head on with the type of care they need, and he seems to have that rarest of all professional qualities -- a serious clue.  I'm a huge fan...

(References to Chaplain John Morris of the Minnesota National Guard on this blog are here, here, here, and possibly here, not to mention, most recently, here.)  In his wonderful essay, linked here, you can read his thoughts on "Beyond the Yellow Ribbon: How Churches Can Help Soldiers and Their Families Readjust after Combat."  (A podcast by Chaplain Morris is linked on another blog, here.)

One Great Book: "Home to War - A History of the Vietnam Veterans Movement," by Gerald Nicosia

"The Past Does Not Equal the Future" -- queue Tony Robbins -- well, unless we refuse to learn the copious lessons of the past, in which case it very well might -- or it might make the past look positively enlightened, by comparison.  Another take on the same thing, by the perennial, inveterate quotemeister himself, Ben Franklin: "Experience keeps a dear [expensive] school, but fools will learn in no other."  I'm reading the greatest book right now, recommended by another journalist who's interested in veterans issues -- "Home to War: A History of the Vietnam Veterans Movement," by Gerald Nicosia, linked here.  It's 2 lbs., 10 oz., 689 pages, and roughly 136 cubic inches of nowhere-else-to-be-found material on the actual history of what created the Vietnam veterans' movement, which informs the veterans' rights movement of today, including the efforts to destigmatize PTSD, figure out what it was, re-include it in the DSM manual for psychiatrists (where it had been removed), etc.  Just fascinating.  All the players are there -- dozens of politically important types, including John Kerry, Ron Kovic (if you've seen "Born on the Fourth of July," you know who he is) as well as therapeutically important ones -- Shad Meshad, Ray Scurfield, Arthur Blank, M.D., Sarah Haley, etc. 

As a late-model Child of the Sixties, I had completely forgotten how much sheer effort -- blood, sweat and tears -- it took to get certain things passed that we now take for granted: better care at the VA, better provisions in the GI Bill, etc.  I had totally forgotten about the armed protests, the hunger strikes and sit-ins at the VA, etc.  It made me wonder whether leaders of the current veteran rights movements actually KNOW this history, and know how far their predecessors had to go, to secure the rights veterans rely on today -- which still need to keep pace with the times, and haven't.  The book is just plain fascinating, and b/c it's relatively neutrally written (as opposed to written with partisanship), with a steadfast focus on the facts and the key participants -- and because it's based on 600 or so interviews with the actual players, it's both extremely well done (a PBS series in book form, but with more depth!) and should keep my interest for quite a while.  So fascinating to know, or begin to hazily recall, the all-important "backstory" of where we are today.  And the insights on the genesis of understanding PTSD are well worth revisiting, all on their own.  Great book - wish I'd known about it before. As more and more veterans send me (unsolicited, I might add) their life stories, or their experiences with PTSD, I have to say -- this book really puts an awful lot together, behind the scenes, as to why they suffered in silence for so long.  Wonderful effort, and a pleasure to read.

Too bad tomorrow is already "Father's Day," but if you're lacking a gift for a veteran dad, Vietnam era or later, and can find this in stock at a local bookstore, it's a superlative collection of everything that went before, and helps us to understand the issues of the present, through the highly informing prism of the past.

Patriot Hills: A Recreation and Wellness Center for Wounded Warriors Planned for Upstate New York

The Albany Times-Union has an article in Friday's paper, linked here, called "A Bridge from Wartime to Civilian Life: Fundraising begins for Patriot Hills, a planned wellness center for National Guard soldiers."  According to the article, Jeannine Mannarino, 48, a retired Army National Guard master sergeant, and dozens of volunteers are creating a nonprofit group to fundraise a planned $21 million to crate a "wellness and recreation center for wounded warriors in the Adirondack foothills."  The article says Mannarino, who is divorced from her husband, a Vietnam veteran who became "a different person" once he had PTSD, "envisions Patriot Hills of New York as the first Armed Services Recreation Center geared to National Guard members and the treatment of military-related maladies," including PTSD.  As the article mentions, "The concept of combat veterans recovering through recreation and professional therapy is innovative and timely," said Mannarino," and adds,

"Patriot Hills would be a therapeutic mountain resort for National Guard soldiers and others who return from war or are diagnosed with trauma. It would give them access to sports and entertainment, but also counseling in a relaxing environment."

This sounds like a great idea.  The National Guard in particular seems underserved, nationally, and we wish this project and Ms. Mannarino, every success.  It will not be the only initiative of its kind: several private initiatives have sprung up over the last few years, but their current status is unclear.  There's the proposed Veterans' Village in Guerneville, California, which is currently getting opposed by its NIMBY-conscious neighbors; and The Sanctuary for Veterans and Families, envisioned by Stacy Bannerman, author of When the War Came Home: the Inside Story of Reservists and the Families They Leave Behind, which seems to have stalled out, either temporarily or permanently.

Survivors Quilt: Combat Veterans Patch Meaning Together in Quilts about PTSD, War and Loss

You've heard of survivors' guilt - here we've got survivors' QUILTS.  (Bad pun, I know -- but true.)

We've been talking a bit lately about art therapy, and how combat veterans with PTSD use it successfully to tap into, and work through, some of the pain they feel inside. The photos here, by Mike Kane, at the Seattle Post-Intelligencer, are from a story published on March 19 about how the inpatient PTSD program at the VA hospital in Seattle has a "wall" of quilt squares, made by combat veterans, and encouraged by a nurse, Betsy Shapiro (she's at right, above), now retired, who gave deeply hurting veterans 6x6" cotton squares, on which to draw something or paint something that related to their experience: something they could leave behind, to let others know about them and what they had gone through. 

Initially, there was moaning and groaning, and reluctance to comply.  But shortly thereafter, everyone produced something, and the results were really pretty impressive.  The veterans also gave input into how they wanted the resultant squares displayed -- not set in pretty frames, like squares in a regular patchwork quilt might be, but together, side-by-side, touching.  The article, by Mike Barber, is called "Veterans tell stories in patchwork of memories," and it's linked here.

In an earlier article, from the Honolulu Advertiser from October 2, 2007, linked here, Glenn Reys, an Air Force vet in Honolulu worked through his recovery from drugs and alcohol by immersing himself in making a Hawaiian quilt, symbolic of his homeland, but also incorporating patriotric U.S. symbols.  He found himself devoted to the practice, and able to quilt for hours at a time.  "This kept me busy," Reys said. "When I do sewing like this, I can sew for like six or eight hours, and it's no problem. That's what I do in my continuing recovery."

In one of the best articles I've read about a Vietnam vet, Cecil Ison, struggling with PTSD, the author, Kathy Dobie, talks about visiting his home in Kentucky and watching his wife, Bet, a quilter, work on a quilt with Vietnam themes. Cecil and his two brothers all served in combat in Vietnam, and each responded in a different way.  Cecil's wife, Bet, attempted to capture her view of what they suffered in the quilt, turning an abstract -- feelings about the war, and the isolation it produced -- into something very concrete -- the quilt. She says that the quilt is too painful for Cecil to address directly, but through it, she is able to give vent to some of her feelings, about what she has watched her husband and his brothers go through.  Kathy Dobie writes:

[Cecil's wife, Bet, and I are spending time one afternoon.] We’re talking upstairs in the sewing room while she works on her Vietnam quilt. The room is stuffed with fabric: tweeds, cottons, velvets, hundreds of men’s ties. Bet sews at a small table by the window. She listens to oral histories of Vietnam veterans as she works. On the left side of the quilt is an army-green map of Vietnam, showing the three cities where James, Cecil, and Arnold served. The rest of the quilt is blue, and three male figures float there, separated from one another and bearing labels: anger, despair, and guilt. The quilt reads: "my husband and his brothers came home from vietnam…three islands in an ocean of silence."  James is the Angry one, Cecil the figure of Despair, and Arnold is Guilt.

(This is the quilt in question, pictured to the right.  From top to bottom, you can see "Anger," "Despair," and "Guilt," and "Vietnam" is written lengthwise, on the left.)  Quilt copyright Bet Ison.

Below is another quilt with Vietnam imagery by Bet Ison.  Both quilts are copyright Bet Ison, and property of the author.  Photos are shared with Bet Ison's permission.

(The article by Kathy Dobie article in GQ, is called "The Long Shadow of War," and we blogged about it earlier, here.  Dobie is also the author of the excellent article in the Nation, recently, called "Denial in the Corps" -- about Marines and the stigma of mental health issues, including PTSD, which we've also blogged about, here.)

Quilting is a uniquely American tradition.  Not that other countries haven't had their own versions of it, but it's uniquely tied up in the "fabric," as it were, of American history.  There are so many examples, from crazy quilts made of just scraps of silk, satin and wool garments, patched together on wagon trains as Americans headed West, to quilts made from flour sacks by pioneer women, to Civil War era "album quilts," to today's photo transfer quilts.  Quilts are often about "making do" with just the materials available, and there's something therapeutic about the needlework involved.  In 1837, American writer Nathaniel Hawthorne wrote in The Scarlet Letter, "Women derive a pleasure, incomprehensible to the other sex, from the delicate toil of the needle."  Well, by the 1970s, even he-men like football great Rosey Grier had picked up the needle, though not necessarily to quilt (he favored needlepoint instead).  Quilting is an unusual 3D art form that combines texture (the fabric, and the stitchwork) with color and design, and has a long and storied American history, besides.  It's interesting that combat veterans and their loved ones would find an outlet for some of their feelings in quilting.  Whether it's a square, a bed quilt, or a wall hanging, quilting allows for freedom of expression, and a form of "art therapy" that may just help those who are hurting to focus and transform their experience into something physical that they can share with others. 

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Editor's Note: If you want to continue this conversation about quilting and paying homage to a combat experience, your own or someone else's, email tributequilts AT gmail DOT com. 

"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.

Sweet Dreams Are Made of This - One Potential Coping Tool for PTSD's Nightmares

"To sleep, perchance to dream..." said Hamlet in his famous soliloquy, in the Shakespeare play of the same name.  It's not so much the dreams PTSD sufferers are worried about, it's the nightmares that bring bad memories rushing back, or otherwise destroy a night's sleep. People with PTSD can be so agitated about their nightmares that they try to put off sleeping altogether, numbing themselves first with drugs or alcohol to keep the nightmares at bay.  (Of course, that creates more problems than it solves, but it's perfectly understandable why that might happen.)  (That's an EEG diagram of healthy, uninterrupted sleep, by the way, at left.)  Now, one novel technique, publicized by a military trauma specialist, may hold out some hope to those whose experience of nightmares prevents them from getting a good night's (and restorative night's) sleep, so crucial to good health, psychologically and physiologically speaking.

In an article published in the Air Force Times of August 9, 2007, linked here, Navy Commander and combat psychologist Beverly Dexter, Ph.D. discusses a somewhat controversial concept she's developed that apparently helps some troops sleep better through the night.  The concept is called "planned dream intervention," although it might more accurately be called, "proactive nightmare intervention," because the goal is to keep a terrifying nightmare from interrupting an otherwise good night's sleep -- essentially by seeing it through to its conclusion, the very thing the sleeping person beset with nightmares usually is too terrified to let actually happen.  I have no idea what to make of this whole concept, and whether it's the concept that's confusing, or the article that describes it just not doing a good enough job of conveying how it really works.  Or, maybe the concept itself has some kinks to work through. What sort of universal applicability does it have?  Only to some types of nightmare sufferers, or does it have validity for all?  Would some types of patients benefit more from this than others?  Does it matter how long (in terms of months or years) people have had the nightmares for?  These and other questions are not really addressed in the article.  It sounds like Dr. Dexter herself says that the concept sounds too good to be true, but she claims it really works, and the article lists a number of examples of people who it's helped.  From the article, it also seems like it's generated a certain amount of buzz as a topic, among troops and military chaplains.  Dr. Dexter, whose bio is linked here, is planning a book on the subject, to come out sometime in 2008.  The book's tentative title is "No More Nightmares:  How to Use Planned Dream Intervention to End Nightmares," but it doesn't seem to be in print yet -- at least, Amazon doesn't have it listed.

According to the article, Dr. Dexter served as the chief of the Combat Stress and Readiness Clinic at Al Asad Air Base in Iraq, and works at the Naval Medical Center in Portsmouth, VA when she's not deployed.

Similarities Explored in How Cops and Troops Experience Trauma Cumulatively, Develop PTSD

Lately we've been taking a look at crucial concept in the linkage between combat trauma and PTSD -- the "dose-response relationship," which is apparently a more or less linear relationship between more combat trauma experienced and greater chance of developing PTSD.  (Earlier blog entries on that topic are linked here and here.)

On the Web, every once in a while you find a gem -- some good and useful material -- in its entirety, and one such "find" is Mary Elizabeth Claire's Ph.D. thesis at Drexel University, available online, called "The Relationship between Critical Incidents, Hostility, and PTSD Symptoms in Police Officers."  (The thesis is linked here.)

While we might prefer her thesis to be about combat veterans and PTSD (heh), the reality is, there's quite a bit of overlap or similarity in how police and veterans experience the events that contribute to PTSD, a fact she explains early on, when she writes:

...Although police officers are usually identified with emergency responders, the context in which police officers experience critical incidents is similar to situations experienced by military veterans. Violanti (1996a) identified six areas of police work that are comparable to the experiences of those that served in the Vietnam War: guerilla warfare at home, the identity of the enemy, a continual sense of insecurity, lack of support, witnessing abusive violence, and depersonalization. The first area, guerilla warfare, is similar to the current plight of many police officers. Violanti (1996a) describes police officers as serving in "peacetime combat."

In a segment entitled, Cumulative Effects of Exposure to Critical Incidents, she writes that:

Learning theory suggests that when an individual is exposed to a repeated stimulus, the person either habituates to the stimuli or becomes sensitized to it. When habituation occurs, the individual reduces their responsiveness to the stimuli while sensitization increases and heightens an individual’s responsiveness. Both behaviors are normal responses but how one reacts to a repetitive stimulus often depends on the intensity of the stimulus. A high intensity stimulus generally tends to sensitize a person to the stimulus while habituation occurs when a person is repeatedly exposed to low to moderate stimuli (Barker, 2001).

It is commonly assumed that individuals that encounter traumatic stressors frequently (e.g., police officers, firefighters) habituate to the stimuli, and therefore they are more resistant to the psychological effects of traumatic incidents. However, the opposing view, that the cumulative effect of critical incidents results in more posttraumatic stress symptoms, has become more empirically supported in recent years (Violanti, 1996b). These findings are congruent with the theories of learning since police officers experience high intensity stimuli on a routine basis thus becoming sensitized, not habituated, to the stimuli.

Several studies have investigated the cumulative effect of critical incidents and the development of PTSD symptoms. For example, Stephens and Miller (1998) conducted a study of 527 New Zealand police officers and found a positive relationship between the number of traumatic events and more PTSD symptoms. Trauma experienced prior to joining the police force was not related to PTSD symptoms while trauma experienced after joining the police force was related to more PTSD symptoms.

Martin et al. (1986) reported that 26% of the 56 police officers attending a sensitive crime seminar met criteria for PTSD. Moreover, the authors found PTSD was related to the number of incidents experienced by the officers. The most frequently endorsed symptom "Recurrent and intrusive recollection of the event" was endorsed by 47 % of the police officers. Martin et al. (1986) indicated it is not surprising that this symptom was endorsed most frequently since police officers continually place themselves in situations similar to previous traumatic incidents and have little opportunity to distance themselves from the incident. Likewise, only 11% of the officers reported in engaging in active avoidance of activities. Moreover, sensitization to the repetitive trauma appeared to occur for these police officers as evidenced by the frequent endorsement of hyperarousal and exaggerated startle response.

Mitchell (1999) reported on the qualitative descriptions of 426 officers above the rank of probationer in the United Kingdom. The officers were asked to describe the most memorable critical incident they experienced during their police career. Almost 75% of the descriptions involved death, and almost 33% of the deaths described involved traffic accidents. Although the Lockerbie Disaster and the crash of the RAF Chinook helicopter were frequently reported, traffic accidents were the largest category of memorable critical incidents described. Different occupational groups within the police department participated, however, 60% of the traffic incidents described as memorable and distressing were reported by current members of the traffic division. Thus, it appears that these officers did not habituate to the incidents in which they were commonly exposed, but instead became sensitized to such incidents. Additionally, the length of time since the accident ranged from two weeks to 25 years with a mean of 5.6 years, indicating that time did not ameliorate the impact of critical incidents in this sample.

Neylan et al. (2002) investigated the impact of critical incident exposure on the quality of sleep in 747 police officers from New York, New York, and Oakland and San Jose, California. The investigators found that cumulative critical incident exposure was associated with nightmares, a symptom of PTSD. Furthermore, sleep disturbances were strongly related to PTSD symptomatology and general psychopathology.

Sleep disturbances and how they contribute to PTSD is another well-deserved treatment that we'll have to leave, though, for another time...

James S. Gordon, M.D., Founder and Director of The Center for Mind-Body Medicine

James S. Gordon, MD, a Harvard-educated psychiatrist,is a world-renowned expert in using mind-body medicine to heal depression,anxiety,and psychological trauma. He is the Founder and Director of The Center for Mind-Body Medicine, a Clinical Professor in the Departments of Psychiatry and Family Medicine at Georgetown Medical School, and recently served as Chairman of the White House Commission on Complementary and Alternative Medicine Policy. He also served as the first Chair of the Program Advisory Council of the National Institutes of Health’s Office of Alternative Medicine and is a former member of the Cancer Advisory Panel on Complementary and Alternative Medicine of the NIH.

 

Dr. Gordon has devoted over 35 years to the exploration and practice of mind-body medicine. After gradating Harvard Medical School, he was for 10 years a research psychiatrist at the National Institute of Mental Health. There he developed the first national program for runaway and homeless youth, edited the first comprehensive studies of alternative and holistic medicine, directed the Special Study on Alternative Services for President Carter’s Commission on Mental Health, and created a nationwide preceptorship program for medical students.

 

Dr. Gordon has created ground-breaking programs of comprehensive mind-body healing for physicians, medical students, and other health professionals; for people with cancer, depression and other chronic illnesses; and for traumatized children and families in Bosnia, Kosovo, Israel and Gaza as well as in post-9/11 New York and post-Katrina southern Louisiana. Nearly 3,000 health and mental health professionals throughout these regions have been trained by Dr. Gordon to more effectively address the psychological trauma within their communities, including supervision and training of a local leadership group within each region which enables the CMBM model to be fully integrated into and sustainable within the local healthcare community.

 

Dr. Gordon’s most recent book is Unstuck: Your Guide to the Seven Stage Journey Out of Depression (Penguin Press). His also the author of Comprehensive Cancer Care: Integrating Alternative, Complementary and Conventional Therapies and Manifesto for a New Medicine: Your Guide to Healing Partnerships and the Wise Use of Alternative Therapies (both Perseus Books). In addition, Dr. Gordon has written or edited 9 other books, including the award-winning Health for the Whole Person, and more than 120 articles in professional journals and general magazines and newspapers, among them the American Journal of Psychiatry, Alternative Therapies in Health and Medicine, Journal of Traumatic Stress, Psychiatry, The American Family Physician, The Atlantic Monthly, The Washington Post, and The New York Times. He also helped develop and write the educational materials to supplement the public television series “Healing and the Mind with Bill Moyers”.

 

Dr. Gordon’s work has been featured on Good Morning America, The Today Show, CNN, CBS Sunday Morning, FOX News and National Public Radio, as well as in The Washington Post, USA Today, Newsweek, People, American Medical News, Clinical Psychiatry News, Town and Country, Hippocrates,  Psychology Today, Vegetarian Times, Natural Health, Health, and Prevention.

Not Specific to Combat, Research Project Studies Use of Tibetan Meditation to Treat PTSD

Although not specifically directed towards combat veterans and PTSD, a research study is currently evaluating whether Tibetan meditation has benefit for PTSD sufferers. Miami and Ohio State university researchers will use an ancient technique to address a modern problem. With a $98,000 grant from the Ohio Department of Mental Health, Deborah Akers, Miami visiting assistant professor of anthropology, will work with co-researchers from Ohio State on a project titled "Treatment of Trauma Survivors: Effects of Meditation Practice on Clients' Mental Health Outcomes."  (For more information about the department conducting the study, click here.) Akers and co-researchers Moyee Lee, professor of social work, and Amy Zaharlick, professor of anthropology, will investigate the impact of Tibetan meditation on victims of post-traumatic stress disorder (PTSD). The project began this month and will continue for two years.

Researchers will work with a group of women diagnosed with PTSD who live in Amethyst House, a women's treatment program for alcohol and drug addiction in Columbus. Tibetan monk Geshe Kalsang Damdhul of the Institute of Higher Buddhist Dialectics in Dharamsala, India, will assist as a meditation instructor. "Participants will be taught specialized meditation techniques and will be guided through meditation for a period of six weeks," said Akers. Results could then provide a new option for treating other victims of PTSD, such as combat soldiers returning from war or victims of natural disasters such as Hurricane Katrina. "This project charts new ground, bringing a holistic perspective to the treatment of PTSD," said Akers. She added that though meditation has been used in a variety of therapeutic settings in the West, such as reducing stress and coping with pain,its application in the treatment of mental illness, including PTSD, has not been extensively explored.

 

"Whereas in the West treatment of PTSD may require years of prescription medicine and counseling, the Tibetan approach has been successful within one to two years by focusing on the spiritual connection between the mind and the body that seems to allow the patient to process the trauma more effectively," said Akers. "Moreover, unlike Western medical therapies, meditation is free and can benefit individuals who cannot afford extensive therapy or medicine over long periods of time. The Tibetan approach is empowering, as it offers PTSD patients an alternative and less invasive form of therapy and enables them to participate in their own treatment." The project grew from a Miami summer field school program, "Peoples and Cultures of Tibet," conducted in Dharamsala, the residence of the spiritual leader of the Tibetans, the Dalai Lama, and location of the Tibetan government in exile. During the field school, Akers and Miami students learned about how Tibetan monks minister to political prisoners and victims of torture who suffer from PTSD. For more information about the program, click here.) Several Miami pre-med and anthropology students will assist in the Columbus project, gaining hands-on research experience.

"The PTSD research project and the summer field program in Dharamsala exemplify Miami University's continuing interest in South Asia," said Akers.

Mind-Body Medicine Conference - Includes Therapies for PTSD

A conference is planned for October 25-29th in Minneapolis, MN on Mind-Body Medicine, geared towards practitioners -- training the trainers -- around the topic, "Integrating Mind-Body Medicine into Clinical Practice, Medical Education & Trauma Healing."  The conference is sponsored by James S. Gordon, M.D.'s Center for Mind-Body Medicine in Washington, D.C.  The Harvard-trained Gordon is a luminary in the field of mind-body medicine, having authored numerous books on the subject, been featured in Bill Moyer's PBS series, Healing and the Mind, and has been a frequent speaker at the Smithsonian, in their public lecture series.  He is a clinical professor at Georgetown University School of Medicine, and is the former chairman of the White House Commission on Complementary and Alternative Medicine Policy.  The Center has done significant work with trauma in the Middle East, Kosovo, in Louisiana with victims of Hurricane Katrina, with 9/11 rescue workers, etc. 

The conference information is linked here. Dr. Gordon's bio is linked here.  The Center for Mind-Body Medicine is linked here.

Honor the Dead, but Fight Like Hell for the Living

A suitable slogan to commemorate this past Memorial Day, and not far different from the motto of the Australian Vietnam Veterans Association, "Honor the Dead, But Fight Like Hell for the Living."  If we're ever going to make signficant progress on treating PTSD as a combat injury, that's what we're going to have to do.  And not just for the living, either -- for the ones who died from what they couldn't endure any longer, as well.

Professor Hedley G. Peach (Australia)

BSc(Hons) (Wales), MBBCh (Wales) PhD(London), FFPH(UK)
University of Melbourne

(Retired) Professor, School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland, AUSTRALIA.

Professor Hedley Peach is a Visiting Consultant at the Ballarat Base Hospital, and Professional Fellow at the University of Melbourne.

Professor Hedley Peach qualified as a doctor in Wales where he became interested in the social causes of illness. This interest led him to train in community medicine at the renowned St. Thomas's Hospital in London where he worked for seven years as a lecturer/senior lecturer. In 1985 he migrated to Australia where he was Foundation Professor of Tropical Health at James Cook University for three years and, subsequently, Professor of Community Medicine at Melbourne University for fourteen years. He retired earlier this year but continues as an honorary Professorial Fellow of Melbourne University. He has been interested in the nexus between religion, spirituality and health for a number of years. In 2002, he wrote the first article on this topic to appear in the Medical Journal of Australia to stimulate debate on how the medical profession should respond to research and recommendations from the USA. He has authored book chapters and papers on spirituality and women's health, the religions of rural Australians, and other topics. He has given many radio and newspaper interviews on spirituality and health. He is the author of several books, including The Epidemiology of Common Diseases and Disablement in the Community, as well as the leading author of more than 100 articles in scientific journals. He is a member of the National Heart Foundation's expert group on psychosocial causes of heart disease.

Soothing Sounds: Dean Evenson and Dudley Evenson Make Music for Troubled Troops

Pacific Northwest musicians, Dean and Dudley Evenson, have found a way they can “support the troops” with their music and DVD offerings.  Their latest release, the Eagle River DVD has found its way to Walter Reed. This beautiful 62-minute DVD with widescreen and 5.1 surround sound features soothing music and visuals of eagles and other wildlife along the wild river in the Pacific Northwest which Dean has been videotaping for the past 15 years.  Also included in the package are Guided Relaxation Bonus Features and a printed Relaxation Training Guide designed specifically to help PTSD and trauma victims.

 

Realizing that many people coming back from combat zones are dealing with extreme physical and emotional wounds, the Evensons wanted to put their music and media to work to help ease the suffering.  For more than 25 years, they have been producing music for health and stress reduction through their independent record label, Soundings of the Planet.  Their music has been so popular with healthcare practitioners that the Evensons realized it could possibly be of benefit to soldiers returning from combat.  When they first contacted Walter Reed several years ago, they found that the head chaplain there, Major John Kallerson, had used Dean Evenson’s music in his own healing process so he was quite familiar with its benefits.  Now he hands out Dean’s music and DVDs to his patients, often amputees suffering the results of IEDs in Baghdad.

 

Chaplain Kallerson told the Evensons “The music helps our patients focus on their healing and not the chronic pain they endure constantly. The soothing music of Healing Sanctuary and Healing Dreams provides a needed respite from the dreams and flashbacks of the terrors that our wounded have seen and experienced.  It is helpful for them to relax and not dwell on the bad dreams or images that they can see… Some find them very helpful to get to sleep.” (Editor's Note: The Evensons have also produced the highly-rated Tao of Healing.)

 

Inspired by this feedback, the Evensons began to research the effects of war and the stress disorders that often plague veterans of violent conflict and learned that soothing music and visuals can offer an antidote to some of the emotional traumas experienced.  They put together a Relaxation Training Guide to help returning soldiers in their healing process.  In this guide, they present concepts and techniques incorporating the music, breath, muscle relaxation, visualization, meditation and mantra that can help anyone dealing with trauma and stress.

 

Last year at Walter Reed, Dean and Dudley Evenson performed for wounded soldiers, their families, and hospital staff. The event was televised throughout the hospital so the staff of 5000 as well as the patients in their rooms could view it.  Behind them played the Eagle River DVD and the response from patients and hospital staff was very gratifying.  They commented that the music and DVD were extremely beneficial in helping soldiers suffering from PTSD and other wounds of combat.  The beautiful natural images of the  Eagle River DVD were also helpful in overcoming the nightmares and images of war that plagued so many of them.

 

Video clips of the Eagle River DVD are available at the Evensons' website, linked here.  Click the special section for Service Personnel which offers information to veterans about using music for health and relaxation.  Soundings of the Planet has initiated a PARTNERS IN HEALING program to receive donations so they can distribute music and DVDs to VA hospitals and individuals who cannot afford to purchase them, To learn more about the Evensons’ music, DVDs, and work at Walter Reed, check out their website, linked here.

WA Legislator Shows Concern for Vets, PTSD

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

Twiggs' Wife: "The PTSD Drove Him Crazy"

Wow...well, for a truly excellent experience, see this raw footage by Arizona TV reporter Suzanne Kennedy, interviewing SSgt. Travis Twiggs' wife, Kellee.  It's great stuff.  Kellee Twiggs speaks her mind, the reporter asks fairly good questions and leaves Kellee plenty of room to talk, and it's long -- which means you get quite an opportunity to hear from Kellee about what Travis Twiggs was going through recently, and how she felt about it.  Really excellent work.  It also clears up a lot of the mystery about what the last few months of Travis Twiggs' life was like, and reinforces the impression we probably already have, about how the Marines are still quite a bit better at fighting wars than they are at tending to the needs of their warriors, and how Twiggs' guilt over losing several men from his platoon weighed on him heavily, and didn't resolve.  Kellee comes across in a great way, and it's very sad at the end of the tape, when she breaks down talking about how much she misses him.  In the rest of the tape she's very composed, under the circumstances, and makes an impassioned advocate for better psychological care for the troops.  Here's the link to the excellent raw interview footage; if it becomes available as a video to embed, I'll add it here as well.  Great work.  Click here for the link.  (See also this later blog entry, linked here, which includes a transcript of the interview.)

Editor's Note: Elsewhere today we've learned that Kellee and her husband, Travis, go way back: they were childhood neighbors in Louisiana, and had been married for nine years, with two children.  That's another way of saying, she really knows the guy, and what's "normal" or "abnormal" in his behavior.

PTSD - "The War Within" - Claims Another Victim

How quickly, it would seem, one can go from badass to bad apple, when PTSD is involved.  USMC Staff Sergeant Travis N. Twiggs, please, say it ain't so.   I so want to believe this is a case of mistaken identity, or that somehow out there might be several Travis Twiggs, roaming America, with their country music star-sounding names.  But at this particular moment, that just seems more than a tad unlikely.

Some background.  On January 8th and then again last month, on April 23rd, we wrote about Travis Twiggs on this blog.  (See entries here and here.)  Twiggs is/was a USMC staff sergeant, from the 2nd battalion, 6th regiment, company G, who had served four(!) tours of duty, one in Afghanistan, and three in Iraq, including most recently in Fallujah.  That's a photo of him on the left, from about a year ago, touring a plant in North Carolina, and thanking them for sending his guys specialized socks in Iraq (Thor-Lo).  I've cropped the photo but he's talking with a seamstress at the plant, and he presented the company with a flag that was flown in Iraq to thank them for their support.  All good so far.

His story initially came to my attention because Washington Post columnist and well-known military author Tom Ricks wrote about Twiggs briefly in January.  Twiggs has been forthcoming about his battle with PTSD, and has told his story compellingly, most recently in the Marine Corps Gazette, in January of this year, in an article entitled, "PTSD: The War Within.  A Marine writes about his PTSD experience."  I wanted to secure Twiggs' permission to retell his story in full on this blog, in his words, but although he attached his email address to the article, and other email addresses have surfaced, no reply was forthcoming to my email requests.  Nor did the Marine Corps Gazette respond.  This, and some things he said in his article, both gave me pause, and made me wonder -- was his story really such a resounding success after all?

Fast forward to the tragedy part of this.  (If you do a people search for Travis Twiggs, you really only find one, nationally, who's his age, 36, so it seems pretty clear this is one and the same person.  From the photos, you can tell that there's also more than a slight resemblance.)  Today my blog statistics were spiking high and it made me curious to see what search was being run.  Cut to the chase: people were looking for news about Travis Twiggs.  And why?  Well, it turns out he's suspected of carjacking a couple's vehicle in the Grand Canyon, there's a manhunt underway for him and his brother, who's suspected in the same crime, and they're both considered armed and dangerous.  News coverage mentions that he's a ten year military veteran (they don't say he's a Marine), covered with tattoos, who suffers from PTSD and is known to behave erratically.

It is heartbreaking to read this news.  What gave me pause about Twiggs' original story?  Two main things.  He attributed, somewhere I read, a signficant portion of his "cure" to spirituality.  Spirituality, while significant to those who believe in its importance, is really an adjunct to treatment, not the treatment itself.  Seriously.  The other reason was, he credited another significant portion of his improved mental health/recovery essentially to working out.  I left that out of the part I quoted, because it just rang so hollow.  Working out is great.  It's an effective, known way to disperse aggression, create feel-good hormones, and increase positive self-esteem.  But in no way, shape or form is it meant to be a cure for PTSD.  It is, again, a part of an effective personal coping strategy.  These two issues created doubts in my mind; the third doubt was planted by Twiggs and the Marine Corps' completely dead silence in response to requests to reprint his article.  On the off-chance he really was doing well, better than expected (and I very much wanted to believe that), his words could have helped many, many people.  However, the lack of response created an impression that perhaps the recovery was oversold, or somehow premature. If you rave up a cure, but you're really not there yet, you definitely want to distance yourself from those words in print when you later on turn out to be struggling.  Very understandable, if that's the case.

I'm so very sad to learn about this armed carjacking.  I very much hope it's not the same person at all.  And I hold out faint hope that even if it is, that it can still work out "well" -- but who knows what "well" would look like at this point.  Prison doesn't sound like fun OR a cure; or even an effective place to get treated for combat trauma.  Marines are in many ways, the best of the best.  (Marketers sometimes joke that the Marines have one of the strongest "brands" in America.  Truly they do.)  They're amazing warriors, but they also can have a habitual reluctance, borne in part by what they do for a living, so to speak, to admit weakness, when and where it exists.  Twiggs made a mighty attempt to admit the weakness he felt, by publishing that initial article, and by taking the rest of the steps he did, to try to get well.  As we have the opportunity to study the effects of combat on veterans, especially in light of combat trauma and PTSD, it's going to be increasingly important, I believe, to take a look at two things, among others, both of which affect Twiggs' own situation.  How many times you've served (which includes length of deployment and time off in between) -- in Twiggs' case that was four -- and what went on when you were there.  Twiggs was in Fallujah, at least on his last deployment.  What happened to him there, and did anything that happen there have bearing on what happened next?

Come to think of it, right at the beginning of Twiggs' own story, he talks about being sent back into combat after already experiencing too much.  That has shades of the Eric Acevedo story as well.  Heartbreaking.  When will the time come when we care as much for the warriors, like Twiggs, as they have cared for us -- by serving?  Sadly, that question is still rhetorical.  Wherever you are, Travis Twiggs, I hope it goes well with you, as much as it can, under the circumstances.  The responsibility for what you're going through is actually shared.

Homeless Veterans: Still Hidden in Plain Sight

The plight of homeless veterans may not be making the news right now as it did around Thanksgiving -- but one thing's for certain: they haven't stopped being homeless in the meantime.

Recently, Homeless Veteran Provider Technical Assistance Center listed our blog as an excellent resource -- thank you.  Note the wonderful illustration at left, done by veteran activist and artist John Paul Hornbeck, creator of the "Shattered Soldier" lifesize sculpture about PTSD, blogged about earlier, here.  John's revisions to the famous POW/MIA flag says quite kindly about the homeless veterans among us, "You Are Not Forgotten Either."  If only that were really the case -- perhaps over time we as a society can make it so.  (He's also cleverly changed "MIA" to mean, "Missing in America," pretty much the same as, "missing in plain sight" -- since clearly the homeless, and homeless veterans in particular, are everywhere, whether we choose to tune in and notice, or not.  (To see more about John Paul Hornbeck's "Shattered Soldier" sculpture, click here, here or here.) 

If you want to learn more about the plight of homeless veterans in America, start here, with the Homeless Veterans Fact Sheet, produced by the National Coalition for Homeless Veterans.  The fact sheet discusses statistics for both homeless veterans and incarcerated veterans.  And the statistics paint a grim and sorrowful picture.  According to statistics supplied by the U.S. Department of Veterans Affairs (VA), the nation's homeless veterans have been historically mostly males (though those figures are likely to change, with the advent of more women serving in the military). 

The vast majority are single, most come from poor, disadvantaged communities, 45% suffer from mental illness, and half have substance abuse problems. America’s homeless veterans have served in World War II, Korean War, Cold War, Vietnam War, Grenada, Panama, Lebanon, Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom, or the military’s anti-drug cultivation efforts in South America. Forty-seven percent of homeless veterans served during the Vietnam Era. More than 67% served our country for at least three years and 33% were stationed in a war zone. (Editor's Note: observe the connection between substance abuse and/or mental illness and homelessness. More work needs to be done to study other predisposing factors to homelessness, including PTSD and Military Sexual Trauma.)

The National Coalition for Homeless Veterans also has a good, web-based list of service providers -- programs that are geared towards homeless veterans.  Click here for that link.  They say they periodically update their website by adding more programs as information becomes available, but right now you'll only find organizations listed in the following handful of states: California, Indiana, Massachusetts, Maryland, Minnesota and New York.  (Click on any of those states' names to go right to the information available on their site.)

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.

The Doppelganger of PTSD: the Unwelcome Stranger Who Follows You Home from War

Over time, more and more grassroots efforts spring up as veterans try to help one another deal with the effects of combat trauma and PTSD.  Some of these are simply conversations, where those who went share what the experience was like, and how they've suffered since -- and ideally, also what they've been able to do about it that helps.  The Peoria Journal Star in today's paper has an article about just such a conversation, held by local central Illinois veterans in conjunction with a traveling exhibit of the Vietnam Wall.  The article is short but poignant in the reminiscences shared by predominantly Vietnam veterans about how combat trauma and resultant PTSD has changed their lives, and not for the better.  Click here for the link to that story. 

There's nothing particularly "extraordinary" or "dramatic" about these men's PTSD or their comments about it -- but that's the thing.  They've very representative of what actual people go through who weren't expecting the experience to scar them for years after combat.  Just one example: a combat photographer with a Ph.D. talks about his own experience. "Divorce, alcohol, drugs, jail, attempted suicide ... I've done them all," he said.  If combat trauma is the stone thrown into the pond, just think of the ripple effects of every item he just mentioned.  Sadly, combat trauma affects not only the participants, but also many of the people in their lives.  Recently I received an unsolicited memoir from a former Marine and Vietnam veteran about his experiences with war and PTSD, and on practically every page the same thing ran true: the enormous remorse and regret he felt from the pain he'd inadvertently inflicted on his family members, because of what he was going through at the time, and couldn't cope with.  Combat trauma, left untreated (and we don't mean, with drugs and alcohol ;-), can become the uninvited guest in far too many veterans' homes and every family gathering.

The German word "Doppelgänger" or "double-goer" comes to us from literature, but seems to have some application with what veterans go through as well.  The Doppelgänger is a person's double, often but not exclusively seen as an evil twin, and often in ominous contexts (premonition of someone's death, etc.).  But in the straight meaning of a connected but separate other self, a veritable "double" self, it conveys what some veterans seem to go through.  The memory of war they've experienced is so profound and powerful, it's permanently "attached" to them.  When they return to society, and have to "re-integrate," the combat self actually never leaves them, and this seems to produce a lot of the pain that they feel.  They frequently acknowledge being "permanently changed" by war -- but yet when the war is over, or when they come back, they're expected to integrate back into society, and into the lives they formerly led.  Many veterans talk about how almost no attention is paid to this experience by the military: you come back, and have to figure this part out for yourself, but it can be deeply troubling.  You can't shake the person you became in war -- in fact, it's always with you, as a "second self."  But at some point you have to come to terms with the fact that both those selves are you, and there is no separation.  In a lot of the pain you hear, see and feel from Vietnam veterans as they share about their experiences, you get a very profound impression that they are in fact feeling shame (and yet connectedness) with the person they became because of war, as well as a desire to protect their loved ones, however incapably, from that very person.  Tremendously, what you also see is a deep desire for other, more recent veterans to profit from their experience.  The "older brothers" (and sisters, but it's mostly men) want their "younger brothers and sisters" not to have to experience the tremendous pain, ostracizing, and neglect they felt -- as well as the inability to come to terms with what it meant.  The Vietnam veterans seem to have a deep, and laudable, desire to become the "readjustment counselors" for today's OIF/OEF veterans.  However, their own healing has to take place first -- and from the expressions of deep pain that get conveyed, you can tell how difficult that healing really is, and sadly, how infrequently it's been able to take place.  (True healing, after all, means going through the pain, processing it, and integrating it into the whole self.  Many people accomplish a "form" of superficial healing, which turns out to abandon them later, by masking over the pain with other "drugs," from drugs and alcohol, to social isolation, to even workaholism, to keep the pain at bay.)

Although we need to write more about this topic separately, even "workaholism" can be a drug to suppress painful memories and experiences.  This "drug" is better suited to some than others -- probably the 'Type A' types "enjoy" it most -- but it's effective as far as it goes, which of course is never quite far enough.  I heard an amazing story from a veterans service officer the other day about the most elapsed time he'd ever seen between someone suffering from combat trauma and realizing he had PTSD.  That's referred to as "delayed onset" but check out how delayed it really was, because of workaholism, most likely.  A World War II veteran, 84 years old.  Had fought in Normandy, Ardennes, the Battle of the Bulge.  He felt he'd led a "blessed life," and had in fact just retired (at 84!).  But in his retirement, with all sorts of unstructured time on his hands, started experiencing nightmares, and would wake up, having soaked the bed.  The nightmares were about what he'd experienced, over 60 years ago(!!!), but which he'd finally had "time" to start bringing up from the vault of memory.  And he was suddenly in terrific psychic pain from this.  Although I applaud the amazing things this man must have done during the intervening 60 years to consider he'd led a "blessed life," I can only wish that he'd also been able to find some healing during that time as well.  Experiencing delayed onset PTSD in your mid-80s, from battle you saw in your 20s, must be a terrible thing indeed.  It's also another reminder about how combat trauma continues to affect veterans from all wars.  And how extending compassion, wisdom and healing to veterans from every war is part of what we ought to be doing, as a society, and often do quite minimally, if at all.

Aspen Institute Forum on PTSD and Iraq Veterans

Thanks to the miracle of the Internet, the full program from last fall's Aspen Institute's Health Forum on PTSD and Iraq War Veterans is available on the Web.  The program was entitled, "From the Front Lines: Post-Traumatic Stress Disorder and the Legacy of Iraq," and it featured panelists Charles Figley, Ph.D., combat veteran Georg-Andreas Pogany, Jennifer Vasterling, Ph.D., and Barbara Romberg, Ph.D..  Click here for the link to the video, or just watch it below.

Women Veterans and Military Sexual Trauma

A study reported in the Journal of General Internal Medicine in 2006 compared rates of Post-Traumatic Stress Disorder (PTSD) in female veterans who had Military Sexual Trauma (MST) with rates of PTSD in women veterans with all other types of trauma.  (The full title of the article is "DSM-IV Diagnosed Posttraumatic Stress Disorder in Women Veterans With and Without Military Sexual Trauma.")

Women subjects were recruited via health appointments and/or a mailing, and completed questionairres about their military service and their health and trauma history.  The results were shocking: Ninety-two percent (92%) reported at least one (1) trauma. Forty-one percent (41%) had experienced MST, either alone or with other trauma, and 90% had other trauma, with or without MST. Overall, 43% of subjects with trauma had PTSD. And most importantly, those women veterans who had endured military sexual trauma had higher rates of PTSD.  Sixty percent (60%) of those with MST had PTSD; 43% of subjects with other traumas (with or without MST) had PTSD. Military sexual trauma and other trauma both significantly predicted PTSD in regression analyses (P = .0001 and .02, respectively) but MST predicted it more strongly. Prior trauma did not contribute to the relationship between MST and PTSD.

The study concluded, "Findings suggest that Military Sexual Trauma (MST) is common and that it is a trauma especially associated with PTSD."  To read the article itself, click here.  (The citation for the study is: J Gen Intern Med.  2006;21(S3):S65-S69.)

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(Quoting from the study):

Rape is a violent crime with long-lasting consequences that is often perpetrated against women. At particular risk are women working within male-dominated environments such as the Armed Services, which, despite a recent influx of women, continue to be composed mainly of men.

National surveys found 13% to 30% of women veterans experienced rape during their military service. What is only beginning to be understood is the long-term impact that military sexual trauma (MST), such as rape, has on the lives of women veterans.

Posttraumatic stress disorder (PTSD) is one of the known consequences of rape. In fact, rape is the trauma most highly correlated with the development of this disorder. Posttraumatic stress disorder associated with rape is long lasting. Further, PTSD itself can cause impaired physical and social functioning. Most of what is known about rape and PTSD comes from the literature on civilian sexual trauma. Much less is known about the relationship between PTSD and MST. Previous studies examining the link between PTSD and MST have identified symptoms suggestive of PTSD or have created models connecting MST with the development of PTSD.

There is only one (1) study, to our knowledge, that examined rates of DSM-IV PTSD diagnoses in women veterans with MST. Suris et al., using a sample of female Veterans Administration (VA) patients, compared rates of PTSD related to 2 types of civilian sexual trauma with PTSD rates related to MST. They found that MST was more frequently traumatizing than civilian assault. Thus, the literature indicates that MST is more predictive of PTSD than are other types of military trauma or civilian sexual trauma.

Women's Mental Health Center ("WMHC") for Women Veterans

The VA Palo Alto Health Care System (VAPAHCS), widely recognized for its innovative treatment and research pograms, introduced the Women's Mental Health Center (WMHC) in October, 2002.

The Center was created in recognition of women veterans and their right to gender-sensitive, high quality mental health care.  The Center's mission, to promote the psychological well-being of women veterans, is advanced via provision of individual and group therapy, and delivery of psychoeducational classes and seminars developed in response to the unique needs of the women we serve.  A few important links:

• The Women's Mental Health Center Home in Palo Alto, CA, linked here.
• A gallery of photos showing the campus and typical attendees, linked here.
• A brochure about the program, downloadable as a PDF, linked here.

Commander Beverly Dexter, Military Psychologist

Commander Beverly Dexter, Ph.D., is an Active Duty U.S. Navy Psychologist who has served three tours with Marines in the U.S. and Iraq.  She is a warfare qualified former Navy Special Operations Officer (salvage diver and ship driver) and former Navy Supply Corps Officer.  She completed operational tours on four Navy ships and frequently gives professional military presentations on leadership, resilience building for military families and prevention and treatment of trauma.  CDR Dexter has lived military life as a single person, double active duty couple, "dependent" wife and mom, deployed mom, stationed overseas and deployed to a combat zone.  She is the Founder and Chairman of the EMDR International Association Military Special Interest Group and the ISTSS Military Special Interest Group.  Dr Dexter is a leader in the effort to improve trauma treatment for Active Duty, Reservists, and National Guard returning from combat and for their families, and has considerable experience serving Army National Guard troops in Iraq.  Dr Dexter is EMDRIA Certified in EMDR and a Fellow and on the Speaker’s Bureau of the American Academy of Experts in Traumatic Stress.  Author of the forthcoming book, No More Nightmares:  How to Use Planned Dream Intervention to End Nightmares (scheduled for release in 2008), she has taught her original theory of Planned Dream Intervention to thousands of individuals who have experienced rapid resolution of recurring dreams and nightmares.

Mental Health of Veterans' Family Members Deserves Attention, Too

Just a quick note to mention that Todd Bowers, Director of Government Affairs at the highly pro-active Iraq and Afghanistan Veterans of America ("IAVA") recently testified before the House Veterans' Affairs Subcommittee of Health about an additionally important topic: the mental health of veterans' family members.  The topic?  "Mental Health Treatment for Families: Supporting Those Who Support Our Veterans" -- that would make a great slogan.  (A few days later, the Christian Science Monitor also covered this topic, in an article entitled, "A New Push to Help Families of Veterans."  That article is linked here.)

It's no secret though perhaps it should get much more attention that combat trauma affects not only veterans but also those in their immediate families.  A veteran's suffering affects his or her family members significantly, as the burden of caregiving falls most strongly on the veteran's immediate family.  There are physical, emotional, social and financial costs to caregiving, not the least of which is strained mental health.  At least with Vietnam veterans, studies have shown that children of veterans with PTSD are at increased risk for suicide themselves. (Although it's the subject of some controversy, an Australian government study of their own Vietnam veterans concluded that children of veterans were three times as likely as the general population to commit suicide.)  It's great to see that the IAVA is making the case that more resources need to be allocated for families' mental health resources as well.  For more information on this important topic, see the IAVA blog entry linked here, or the House subcomittee's site, linked here.  For a link to the audio coverage of the hearings, click here.  For earlier blog posts on caring for the caregivers, click here; or about the family, click here.

Editor's Note: It's interesting to note that just today, the Australian government published its conclusion, that counseling services would be made available to their veterans and families.  To read more about it, download this PDF.  To learn more about the Australian Vietnam veterans health studies, click this link to a subsequent blog post.

When "Luck" Doesn't Seem So "Lucky" After All: Coping with Survivors' Guilt

Survivors' guilt, at its most basic, is about coming to terms with the very arbitrary nature of luck/fortune/chance.  Some tragedies in life pass by us; others touch us directly.  Woody Allen had an old joke, when someone asked him if he'd like to achieve immortality through his work.  No, he said, "I'd like to achieve immortality through not dying..."  Cynics might claim that those who die have it easy -- at least they're not left to deal with the wreckage.  For those left behind, when a tragedy occurs, the grieving can seem harder than the going.  And the incessant questioning, "why ME?!"  Sometimes luck doesn't feel so lucky, when it's someone you deeply cared about who died, and you're left behind to carry on.  Go ahead and excuse the surface-y nature of this post, please.  There's obviously a lot more to survivors' guilt and how it makes people feel, as well as how to overcome, than this little cheese-whiz post is going to convey.  It's not meant to be a quick fix.  However, in the spirit that sometimes it's worthwhile to challenge your unconscious thoughts about a situation that plagues you, here are some items I ran across a few years ago on the Web.  Attribution unknown, sorry to say. 

Survivor’s Guilt - Opportunities to Challenge Your Thinking

• Thank goodness -- you survived!
• More people than you know are happy that you survived.
• Over the course of a lifetime, we are saddened by so many deaths
• Even if the rest of your life seems insignificant to you, we are relieved that you are alive
• Know that there is no shame in surviving
• It is good to survive
• It is okay to delight in being alive
• Feel free to reassess your life
• Reassess what is valuable to you
• Make the best of your life
• Making the best of your life can be a tribute to your survival and to those who died
• Take the opportunity to re-evaluate the meaning of your life
• Is your life all it can be?  If not, why not?
• What is or can be your purpose? your talent? your benefit to life?
• Bloom where you’re planted
• Process the traumatic experience and its associated symptoms with the appropriate assistance
• Put guilt to good use
• If it is in your nature to do so, cherish life
• Treasure being alive
• Whether you survived due to fate, a purpose, luck, chance, or you just did," it's a truth that long life and kindness are not guaranteed to any of us
• Each day and each act of kindness can be treasured as gifts
• Treasure the best of each day
• Be aware of your physical mortality in good and positive ways
• Understand that appreciating or cherishing life may be easier after recovery from trauma
• Recognize the reawakening of old issues
• Survival may have triggered old feelings of worthlessness or unworthiness
• Surviving may have amplified old messages that you received about not being worthy, about being a nuisance, about not measuring up, and/or about not counting
• If guilt persists or disrupts life, seek appropriate therapeutic assistance

Editor's Note: One instructive book about the general topic of how to process grief is, Living with Grief after Sudden Loss: Suicide, Homicide, Accident, Heart Attack, Stroke," edited by Kenneth J. Doka, Ph.D.  Although the subtitle there shows you there's not just one type of death discussed, it fails to mention that there's also a chapter in the book called "Complicated Grief in the Military."  The book was published in 1996, so it doesn't take this war into account, but the principles are general and reasonable.  In the conclusion to the book, Kenneth Doka, Ph.D. lists five critical points about surviving grief.  They are: "that grief is a highly individual[ized] reaction; that different types of sudden loss create unique issues for survivors; that survivors are often coping simultaneously with both grief and loss of their normal world; that survivors of sudden loss need both short-term and long-term intervention; and that caregivers at all levels may be affected by traumatic loss, so self-care is critical."  He notes, finally, that "communities need to be proactive."  That's what we're attempting to do, here.

Loving Someone with PTSD - How It Affects You

The VA has an excellent "Fact Sheet" devoted to the special problems and opportunities of PTSD in a relationship.  It's well worth reading.  Click here for the link.  The fact sheet is entitled, "Partners of Veterans with PTSD: Caregiver Burden and Related Problems," but the "related problems" are so many more than alluded to in that simple and generic title.  In the "meat" of the fact sheet quite a few topics are covered, including: marital adjustment and divorce rates; interpersonal violence and domestic violence; mental health of partners (because PTSD can have a negative effect on others, as well); and caregiver burden.  If you or a loved one suffer from combat trauma, please take the time to read and review this short but useful handout.

Why is this topic so important?  As the fact sheet says, "Research that has examined the effect of PTSD on intimate relationships reveals severe and pervasive negative effects on marital adjustment, general family functioning, and the mental health of partners. These negative effects result in such problems as compromised parenting, family violence, divorce, sexual problems, aggression, and caregiver burden."  That's a whole lot of important topics, with significant impacts on the individual sufferers, and their friends and families.

Aphrodite Matsakis, Ph.D., and Patience Mason have both written powerfully about the spouse and family member's experience of a veteran with PTSD.  Matsakis' most recent book is Back from the Front: Combat Trauma, Love and the Family.  It's somewhat of a restatement of her earlier classic, brought up to the present, called Vietnam Wives: Facing the Challenges of Life with Veterans Suffering Post-Traumatic Stress.  Patience Mason, who's devoted the last umpteen years to writing words of wise counsel to others about living with a PTSD sufferer, authored the classic, Recovering from the War: A Guide for all Veterans, Family Members, Friends and Therapists.  As Charles Figley, Ph.D., writes about the topic, these women both know "about living with someone with a disability (PTSD) that, like a disease, destroys people and their relationships with others."

Superb Writing about a Vietnam Vet's PTSD and Subsequent Nervous Breakdown

GQ magazine has a superb, hauntingly beautiful (and eloquently written) article called "The Long Shadow of War."  The description reads, "As a young soldier in Vietnam, Cecil Ison saw something, something so horrific that he buried the memory of it for thirty years and swore he'd never allow it to surface again.  Then, on March 20, 2003 -- the day after we started bombing Iraq -- the past leapt up and grabbed him."

There's no two ways about it: this is the best writing I've read in years, especially on this topic.  The story is long -- but practically every sentence is a gem.  It covers most of the grand themes surrounding PTSD in really an epic sweep.  There's the Vietnam War itself, always a player; Cecil, the cantankerous Appalachian individualist at the center of the story; his lovely, long-suffering and adorable wife, who loves and attends to Cecil and his various states, and quilts something lovely for him and his brothers about their Vietnam experience; his two brothers who are also battling their own demons from war, but handling it differently; his mother, who sent all three sons off to Vietnam to fight; the VA and its therapists, who minister to Cecil in his nervous breakdown; the countryside, whose silence and remoteness helps nurture Cecil in his darkest times; and finally, the writer, Kathy Dobie, whose talent is just off the charts phenomenal.  (Although it's also a close race with Cecil himself, and his wonderful wry way of putting his life into perspective, when he can, reminiscent of the humor of that 60s icon, Richard Brautigan.)

An example, from Cecil, when Kathy the writer asks him if he's a Vietnam vet:

“Yes, I received a letter from the president of the United States one day,” he said with sardonic cheerfulness. “I was out playing Whiffle ball, just having a wonderful time, and I got the mail and it said, ‘Greetings. Your friends and neighbors have selected you to serve in the Armed Forces.’ At that point, I knew I had no friends and no neighbors.”

As just one small example of the writer's deep psychological attunement and her innate grace with language, she first bonds with Cecil, thinking about his breakdown, by sending him the opening lines from Dante's Divine Comedy: "In the middle of the journey of our life I came to myself within a dark wood where the straight way was lost."  He responds a few days later with, "The mind is a strange thing—how it can paint over harsh images for decades but then for some reason they can emerge as quickly as the bare wood on a whitewashed fence after a rain. (One thinks) this is something that other people experience but not me, until it strikes like a blow from a sledge hammer. You are most welcome to explore my condition. I’m still struggling with the fact that this is a real condition and many, many others struggle with the same thing…"

Dobie is the best writer I've read in I don't know how long, on a topic I absolutely love.  She's the author of a memoir about trauma called, The Only Girl in the Car: A Memoir, a fact which explains some of her sensitivity and emotional depth in the Cecil Ison story.  Apparently she sold that book to the publisher on the strength of the book's "brilliant writing and emotional power."  Fantastic.  What a wonderful treatment of a powerful topic, and a quirky, charismatic "hero."  (His wife is also a hero, and sounds just adorable.)

A Military Dad Looks for Answers -- and Action -- in Aftermath of Soldier Son's Suicide

NPR had an excellent story on Tuesday about the proactive anguish of retired Master Sergeant Chris Scheuerman in the aftermath of his son Jason's suicide while deployed in Iraq.  It's a story everyone should read, because it raises any number of salient points about the topic, including who military psychologists are really working for anyway.

The main article is called, "Father Blames Military for Son's Suicide," and if you read the story, you'll see why that is.  The text of Army Private 1st Class Jason Scheuerman's suicide note is included, and it's quite sobering.  There are several linked stories that are well worth reading as well: The timeline of Jason's last days is here.  And the article that the Associated Press did about Jason, "A Soldier's Suicide: Did He Have to Die?" is also linked here.  If you want a short course in what the issues are surrounding young soldiers who suffer combat trauma and are driven to kill themselves, these three articles give a pretty good education in the basics.  There's no shortage of participants behaving badly, and the "system" not really "working" to protect a very troubled soldier from himself. 

It's actually pretty heart-breaking to read the story, and to put yourself in the place of the dad, who was highly tenacious about finding out what really happened to his son.  The truth gets revealed to him little by little, as documents he demanded from the Army under the Freedom of Information Act (FoIA) slowly trickle their way to his house.  The Army doesn't even initially release the son's suicide note; in fact, they say there wasn't one.  (It shows up randomly later on.)  It's pretty clear that if this were a civil situation, the "employer" would be sued for wrongdoing, and there would be the potential for an enormous jury verdict for the family.  But in this case, the employer is the Federal government, and as the dad says, when the Army psychologist is an arm of the "employer," it's very unlikely that they're going to go against their self-interest, and advocate for the troubled soldier.  According to NPR's story, Chris Scheuerman says, "Military psychologists work for the employer. Their career is ...[dependent on or tied to] the decisions they make to ensure that soldiers go back to the front. That is an inherent conflict of interest, and I believe that conflict of interest prevents the provider from being a true advocate for the patient."  Scheuerman concludes, "The psychologist who saw my son was not an advocate for his safety."

Read the articles -- Jason Scheuerman's situation is hardly unique.  (We've blogged recently about the rash of young soldier suicides, including here.)  There are way too many Jasons who aren't being helped when they need it, and who not only fall through the cracks, are sometimes even given a nudge or a push. In Jason's case, that's basically what happened.  Was it malicious?  Or just incredibly insensitive and poorly timed?  Who knows.  It certainly was tremendously ill-informed, and counter-productive.  Poor Jason and his family.  It seriously sucks to be mis-understood by everyone around you, at the time when you need help the most.  Let's hope his death isn't going to be in vain -- that's exactly what his family hopes.  I'm glad they had the courage to make their painful story public -- it will help show the way to other agonized families, in the wake of son's and daughter's suicides, how to backtrack and really find out what happened.  And probably the biggest "lesson" of the story: how do you throw someone a lifeline when they really need it, and not miss that chance?  Or worse, push them off the ledge? 

And what, if any, is the duty of care owed to a troubled soldier when he or she sees a psychologist on the battlefield?  Is it substantially different from that in civilian life?  Because it seriously seems as though Jason's case was handled poorly.  He didn't help matters -- "contributory negligence" -- but seriously, he was sick.  It's much more concerning the overall low level of perceptive, sensitive treatment with which his fairly dire case was handled, by pretty much everyone he came in contact with.  Anyway, soapbox over.  Great articles on a troubling topic.  Well worth reading and thinking about. 

Young Veteran Suicide Honored

Military.com has a story today about an AMVETS post in Minnesota being named in honor of a young combat veteran who took his own life.  As extremely tragic as the needless death of Army Specialist Noah C. Pierce was, at the oh so young age of 23, the "good" that comes from this event -- the naming of the AMVETS post -- is that it succeeds in taking some of the cultural sting out of this topic, and expands the reach of the concept we so need to hear as a nation, that not every combat-related death ends on the battlefield.  Many stretch past that into civilian life, as vets attempt to integrate and recover from what they've seen, done and experienced.  And their deaths should be no less honored by their communities and their country.

Editor's Note: ABC affiliate WDIO has a good article on Noah Pierce's mom's efforts to get his story out there.  Click here for that link.

What They Found in the Wastebasket

The McClatchy newspapers continue their great series about whether and how the VA system is serving, or under-serving, returning combat veterans with PTSD.

In their recent story, "Suicide Shocks Montana into Assessing Veteran's Care," which by the way is an excellent fact-filled article, there is this troubling mention about what Chris Dana's dad found in his wastebasket, after Chris shot himself last March.  Let's let the McClatchy papers tell the story:

HELENA, Mont. — Chris Dana came home from the war in Iraq in 2005 and slipped into a mental abyss so quietly that neither his family nor the Montana Army National Guard noticed.He returned to his former life: a job at a Target store, nights in a trailer across the road from his father's house. When he started to isolate himself, missing family events and football games, his father urged him to get counseling. When the National Guard called his father to say that he'd missed weekend duty, Gary Dana pushed his son to get in touch with his unit. "I can't go back. I can't do it," Chris Dana responded.

Things went downhill from there. He blew though all his money, and last March 4, he shot himself in the head with a .22-caliber rifle. He was 23 years old.

As Gary Dana was collecting his dead son's belongings, he found a letter indicating that the National Guard was discharging his son under what are known as other-than-honorable conditions. The move was due to his skipping drills, which his family said was brought on by the mental strain of his service in Iraq.

The letter was in the trash, near a Wal-Mart receipt for .22-caliber rifle shells.

All across America, veterans such as Chris Dana are slipping through the cracks, left to languish by their military units and the Department of Veterans Affairs.

It's implied, but not stated, that Chris Dana might have been driven to suicide by the one-two punch of PTSD and then being discarded by his own unit as unfit to serve (and therefore to collect benefits).  The timing is certainly...troubling.  It's a heartbreaking story, and it wouldn't be surprising if it is, in many ways, being played out all across America, as returning veterans struggle with their own private demons -- grief and loss and trauma, from combat -- and find a system that not only doesn't embrace them, but makes it difficult for them to find the care they desperately need, when they need it.  In Chris Dana's case, the system created more difficulties for him -- not helped him deal with the difficulties he already had.

---

I've read a lot of stories by now about young veterans killing themselves, and my sympathies are really with them.  Not instead of the veterans who, battling their own demons as well, end up harming others, sometimes but not always before harming themselves.   One common thread to the stories where young vets take their lives is they often are aware that they have a problem, but the timing is bad about getting help.  They, and their families, are often aware that something is wrong -- Johnny went off to war but didn't come back the same sweet, fun-loving guy who left -- but the drag is, they can't get in to get seen in enough time by competent mental health professionals.  There's often an unconscionable wait to be seen at the VA.  And of course they're often also pretty well-mired in the not-exactly-advantageous experience of self-medication with drugs or more commonly, alcohol -- to keep the demons at bay.

So they don't get seen in time enough, even though everyone knows something's desperately wrong, and the next thing you know, they're dead, and they're leaving families who are quite shell-shocked themselves by the double horror of having their child come home from war a substantially different person, and having them take their own lives, often in the family home.  There's such a list by now, of callow young men, deep in a struggle with combat trauma, not getting the timely help they need, and dying by their own hands, leaving anguished families in their wake.  Joshua Omvig, Jason Cooper, Jeff Lucey, Noah Pierce, Chris Dana, the list literally rolls on...120 a week.

---

It's becoming apparent that PTSD is, in many ways -- except for the possibility of windfall payout -- a real lottery.  It's a lottery whether you'll get it -- not everyone who goes to or through combat, does.  It's a lottery when it will  happen -- it often shows up a delayed interval after combat, not immediately (immediately would be more convenient for everyone).  (In fact, it can show up many years -- as in, decades -- later.  That's why you see Vietnam-era vets finally realizing they have it, as they reprocess their own trauma in sync with veterans coming back from Afghanistan and Iraq.)

There are a few more lotteries, though.  It's a lottery whether the VA will know how to treat you -- you'd be unhappily surprised if you saw the searches various VAs do on this very blog.  Doesn't exactly inspire confidence that they know the direction to go in; seems quite a bit more like they're clutching at straws.  It's also going to be a lottery whether you'll get evaluated in a competent way, and ascribed the correct percentage of disability.  News reports lately, particularly from the McClatchy Newspaper chain, which did its own independent research, show that VAs vary widely from state to state in terms of how they confirm or compensate PTSD in their centers.  (We blogged about it, here.)  It's also a lottery whether the military will even see your case of PTSD for what it is; because it might create behavior problems that they start to see as failures in discipline, and demote or discharge you because of it (as they did in Chris Dana's case), and then you really won't be in a position to pay for your own care.  And of course, it's really a lottery to see if your family, community, job, and social network will embrace you, accept you, or reject you. (It won't have much to do with your own worth; more to do with them, but no matter.  It'll still hurt.)  Then there's the lottery of whether you'll be able to afford to live on the meager proceeds of your disability pay, should you be "lucky enough" (there's the lottery concept again) to receive any.  And the true, ultimate lottery of whether you'll end up becoming homeless -- a good one quarter of homeless males in America now, and the figure stands to go much higher, has been show to be veterans, many of whom have PTSD.

And of course there are also the lotteries of whether you'll become addicted to drugs and alcohol, in your quest to cope with the pain and self-medicate, either while you're waiting around for the VA to see you and/or take your case seriously, or, just because it's a socially-acceptable option that's within easy reach, and in some ways more instantly accessible than dealing with the ups and downs and unknowns of medications offered.

The only problem with all these lotteries? (and they are gambles, after all...)   No positive payout.

I'm beginning to think, as I read story after story in the press of hapless veterans colliding with a system that doesn't care, and harming themselves or others, or just plain checking out, when they've reached the wall and can't find, or get, help for their suffering -- that the only "lottery" I know that resembles this is a very famous one indeed.  "Survival of the fittest," a phrase that came to prominence with Charles Darwin, and the concept of natural selection.  Only the very strongest can survive: the sick, the weak, the ailing, all fall behind and get taken out.  Combat trauma -- a very natural reaction to very unnatural events -- weakens those it affects.  And the system, such as it is, exemplified by the VA -- doesn't really stand ready to help in any pro-active, instantaneous, constructively helpful way.  Not to mention, it's almost impossible for those traumatized to simultaneously also aggressively advocate for their own care.  So the veterans who are struggling with trauma are weakened, and the system picks them off, one at a time -- by attrition, if not by outright neglect.  I think that's why you see some Vietnam-era veterans jumping in to do what they can to help young vets just coming back.  They literally don't want to see today's crop of veterans have to struggle as long or as hard as they've had to for the care that they need. I applaud the heart behind those vets' efforts, but at the same time I'm discouraged that, if PTSD is a lottery, we can't have a care system based on natural selection -- where only the strongest can survive its delays and haphazard care.

NOTE: Callow -- it's not an insult, it's a description.  It means, lacking adult maturity or experience.  Which sometimes allows you to put into perspective that whatever you're going through is not worth killing yourself over.  Sometimes, but not always.

Don't Make it a Blue Christmas - Veterans, Depression, Suicide and the Holidays

There is a dominant impression that many of us have that suicide somehow spikes at the winter holidays.  Fortunately this turns out to be just a myth -- though there is an increase in suicide after the holidays -- perhaps in part because of the general letdown after a period of increased stress, combined with frequently crummy weather and potentially mounting financial pressure from holiday overspending.  Even if suicide didn't peak anywhere near this time of year, it's still worth looking at what can be done to help people feeling the pressure and stress of the holiday season.  Combat veterans (and their families) face special stresses at holiday times, including increased time with family and friends, often increased exposure to alcohol and drugs, and the special pangs of realizing loved ones -- combat buddies -- are no longer with them or able to celebrate the holidays with their own families (survivor's guilt).

Fortunately there are some decent resources out there for lending a hand.  First off, the generic but helpful ones; secondly, the more veteran-specific ones.

Good, generic advice:

• "Ten Tips for Coping with Holiday Stress" 
• "How to Remain Sober and Healthy During the Holiday Season"
• "Dealing with Grief in the Holiday Season"

An excellent one on "Coping with a Family Member's PTSD During the Holidays;" and

Veteran-specific advice:

• Article by a Vietnam-era vet, who tried to kill himself on his first Thanksgiving back after combat.  He's got a very interesting point of view in this article.  One of the things he says is that since he arrived in Vietnam first on Christmas morning, it was hard for him for years afterward to ever have a good Christmas.  He covers all the big topics from his point of view, including anger, flashbacks/hallucinations, fear, dread, hyper-vigilance, anxiety, intimacy issues, drug and alcohol abuse, avoidance/immersion, sleep disorders, guilt, memory loss/cognitive dysfunction, intrusive thoughts, and depression.  Pretty good stuff, and he definitely can relate.  He also talks about "anniversary reactions," which is another important topic in the discussion of veterans and combat trauma.
• Patience Mason's wonderful advice for veterans and their families.  This is a link to an article specifically on "PTSD and the Holidays," and it's quite comprehensive and excellent.  She also covers the anniversary reaction the veteran may be having, and talks about how to create a healthy balance between who can handle what at the holidays, without fostering resentment and anger between the veteran and his or her loved ones.  Excellent stuff, again from someone who can relate.

Report Calls It "Highest Year Ever for Army Suicides"

USA Today has a story today about how an upcoming report will show that this past year, more Army soldiers killed themseles than ever before.  As the article states, "A total of 109 suicides this year would equal a rate of 18.4 per 100,000, the highest since the Army started counting in 1980. The civilian suicide rate was 11 per 100,000 in 2004, according to the Centers for Disease Control and Prevention [the CDC].

According to Senator Patty Murray, whose office shared the statistics with USA Today, and who is quoted in the article, "The military hasn't erased the stigma surrounding mental health issues, so troubled soldiers often do not seek help."  "I want to say I'm surprised...But when we're not doing everything we can to deal with mental health, when we know the Army is under such stress, it's not a surprise. It has to be a wakeup call."

(Although honestly, we should be well past wake-up call on this one.)

The article also mentions efforts the Army has made to combat the problem, including "mandatory training for every soldier about mental health and establishing a program to study its suicides."   However, a troubling angle to the whole suicide phenomenon is this one -- "Research released by the Army in August shows that almost 70% of suicides in 2006 were spurred by failed relationships."

Meaning, the soldier was already under significant stress, and the death of a key relationship just piled one more stressor on, and became the proverbial "straw that broke the camel's back."

If there's a concept like "total load" with mental health issues, it could very well be that ordinarily, people are capable of handling "only so much" stress, and when more gets added to the pile, it's hard not to topple under the strain.  Each person may have their own "breaking point," whose relative location changes regularly, according to how much stress they're under, or how much support they can count on (in addition to a number of other things.)  We're also talking about a younger military here than in years past, including many who didn't expect to be signing up for such extended tours, or possibly even war in the first place (okay, they should have considered it, but many did not).  Reservists in particular -- I can think of several people I know who joined to get better civilian benefits, and weren't remotely thinking they'd end up serving in Iraq or Afghanistan.

It will be interesting when more data comes out, and is studied in greater depth, to also take a look at prevalance of suicide, and see what else it's linked to.  There's already some concern, backed up by studies, that PTSD affects some troops more than others, and suicide would seem logically to follow those same trends.

In the meantime, thanks to Patty Murray for being a great supporter of veterans.  As a longtime Washington state resident, I remember her first being elected to office, and being derided and dismissed during the campaign as a "mom in tennis shoes," whose background as a teacher didn't qualify her for anything political.  As her background material indicates, she's the daughter of a disabled World War II veteran, and she's turned out to be an ardent veterans supporter, and the first woman to serve on the Senate Veterans Affairs committee. 

For media coverage on the great things she's done to support veterans, read the lower half of this page from her Senate website.  As one Seattle newspaper describes her, she's a "workhorse, not a showhorse" -- and thankfully a very committed veterans supporter.  We need more.  (This link to Project Vote Smart shows her voting record.)

Editor's Note: In related and current news, read the transcript of Todd Bowers, IAVA's director of government affairs, remarks as he testified before Congress yesterday on the topic of veterans suicides.  The transcript of his remarks is linked here.

Trauma Listening Skills - Listening with Focus

I had an interesting lunch the other day with John Powers*, up-and-coming veterans support specialist, current studying to become a psychologist, and one of the take-aways from the lunch was his impression of just how much veterans want to be heard.  Over and over, this seems to be a theme.  The contrary impression is also true: veterans who suffered because they felt society pushed them aside, and what they had to say, when they came back from the Vietnam war -- part of why, ideally, we are somewhat more ready to listen as a society now.  We think about quotes like Paul Tillich's, that the first duty of love is to listen, something we talked about earlier in a blog entry called, "How Do Veterans Want Us to Listen to Them?"  (For everyone Googling for "gifts for returning vets," and there are quite a few who are, try thinking about what USMC Brigadier General Timothy C. Hanifen wrote here in "Three Gifts You Can Give Returning Veterans That Last a Lifetime."  For everyone who wants the Cliff Notes version, even his three keys are somewhat listening-oriented: understanding, support and affirmation.  Try giving those in a genuine or authentic way, without listening -- pretty much impossible.)  There's even a specific book we talked about lately, that veterans and their families could use to document their recent experiences, both positive and negative, in an informal and interesting approach.  (That book and its related national project is called Listening is an Act of Love.  Here's the link to that blog entry.)

There's more and more we could say on the subject, but here's the actual point, and the rest was merely prologue.  There are specific skills involved in listening to and working with trauma and those who are affected by it.  Thankfully, there are also resources on learning how.  Here is a great link, that covers quite a few approaches, in tidbit fashion -- in other words, leaves you wanting more.  The overall gist?  That listening must be very intentional, and with focus.  What is focus?  The dictionary would say, it's narrow or close examination or concentration.  It's the sense that everything else is slipping out of focus, and only one thing is at the center of attention.  Listening with focus: it's a good idea in general life, an even better idea, apparently, with those who've suffered from trauma.  Perhaps this holiday season we could begin to practice it.  Guaranteed there's an enormous need for us to learn how.

Editor's Note: That's not John's ear, btw.