Healing Combat Trauma

We Made History Together: The Oral and Written Histories of Combat Veterans

Combat veterans - where did your memories go?  Not as in, "have you lost your memories?" but more to the effect of, "how are you saving them or transmitting them, for posterity?"

This marvelous photograph was taken by photographer Jeremy Hogan, and is used with permission. Hogan wrote the "Poem for My Father" which we blogged about earlier, and in his free time, he's helping to document the history of his father's squadron in Vietnam.  He says about this photo, taken over Memorial Day weekend, that the subject is, "Ron Klus, who served with my dad at Quan Loi, and received a Distinguished Flying Cross with an Oak Leaf Cluster. Unfortunately, Klus died due to issues related to his PTSD and now the VA is now denying his widow death benefits."

Recently, I've been privileged to receive several veteran's memoirs, bound up in book form -- one is a work in progress, the other already published.  I know that Jeremy is working with at least one of the guys from his dad's old squadron (13th Signal Battalion, part of the 1st Cavalry Division Airmobile), a combat photographer who did multiple tours of Vietnam, on cataloging his old photos, and creating some sort of archive for posterity.  That photographer says he's been interviewed as well, and is the subject of an upcoming article in a military magazine, but admits that dredging up the memories has been extraordinarily painful, because all those memories just come rushing back, from where they've been suppressed all these years.  That situation is challenging enough -- but what of others, who will die before they set anything down on paper, or on tape, about what they went through?  Those memories, painful and otherwise, which capture who the person was, will forever be lost to time. Unless...they're preserved some kind of way.

We've written on this blog before about the exceptional StoryCorps project -- click here for that link -- but what else is there out there, that archives veterans' recorded stories of their adventures and misadventures in combat?  (By recorded, we mean "set down" -- which could be on paper, digitally, or taped.)  One thing I've run across -- and please let us know if you know of other things like this, that are national in scope, not just regional or local -- is the "Veterans History Project," a project of the "American Folklife Center" at the Library of Congress, linked here. 

To participate in the project takes a few easy steps (their words, not mine), and seems pretty straightforward.  You register for the project, print the project field kit, prepare f the interview, conduct the interview, and send the resulting work product to the collection at the Library of Congress (of course keeping at least one copy for yourself).  Students and teachers can make this an educational project for school credit, -- that information is linked here -- but veterans themselves should think about getting involved. There's even a very cool place on the site where you can search for histories by other people who've participated -- for all you know, you might find a wartime buddy via that search engine, which is linked here.

I recently shared a quick conversation and a hug with longtime Friend of Veterans Maxine Hong Kingston, and asked her my one burning question, which was how long it took veterans before they were willing to talk about their experiences.  She said, "20 years."  I'm hopeful it doesn't always take that long -- or won't take that long, for the current crop of veterans -- but when you read some individual's war experiences you can see exactly why that would be. 

Current veterans like Tony Neff, author of the short autobiographical piece on his injury and convalescence, called "All I Want Is What I Deserve," which was published on this blog a few months ago, definitely took the plunge and jumped right in -- good for him. (His story is linked, here.)  I just have the feeling the current group of vets, thanks to the Internet and technology, etc., and their general comfort level with same, is going to break through all previous barriers more quickly with getting their stories told and out there, for the general public and to memorialize what they went through. In fact, it will seem unusual for them not to! 

But for everyone else, from previous wars, it's gonna take a little more coaxing and cajoling. So what of it -- is it time to start getting involved, and sharing with the world what only you know and experienced?  It might even help your loved ones understand you a little bit better -- and in the process, perhaps help you to understand and forgive yourself a little more, too.  Can you hear me cheering you on from the sidelines?  That's good -- because that would be the point :-)

Ambrose Bierce - Cynic, Soldier, Journalist (and Early TBI / PTSD Sufferer)

You may already know who Ambrose Bierce is -- contemporary of Mark Twain -- American "humorist" -- but with the most dark and biting, bitter humor around.  (So bitter, in fact, that in his later life, he was known as "Bitter Bierce."  He's famous for some short stories, including the inimitable "Incident at Owl Creek Bridge," which occasionally salvages an otherwise-deadly literature anthology for high school and college students, and also the Devil's Dictionary, which is truly just one of a kind, from which come many of the best "definitions" I've ever seen, about the out and out hypocrisy of language and typically revisionist history, written by the victors.  In fact, though they were rivals, the sentiments behind Mark Twain's famous "War Prayer" -- "Oh, dearest God in the heavens, smite down the other side, mainly because they're not US" (I'm paraphrasing) -- fit right in with Bierce.  While literature types make much of Bierce's cynicism -- he's been relegated to the "humor" side of the aisle, in theory, because of it -- the reality is, he was a soldier who saw many battles, and saw some truly horrible things, in the course of his serving in the Civil War.  Things that jump right out of the pages of his writing, and underscore realities from Vietnam -- like the impetus behind fragging -- and the wars in Iraq and Afghanistan -- including what must have been a "traumatic brain injury" or "TBI" -- when he was shot in the head with a musket in one of the battles in which he participated.

If you fast-forward to the 1980s, Bierce's eventual disappearance in Mexico -- he had gone there to fight -- is chronicled in the fictional movie treatment, "Old Gringo," starring the eclectic cast of (erm) Jane Fonda, Jimmy Smits, and Gregory Peck, as Bierce (he's the "Old Gringo" of the title.)  (The movie was based on a novel by Carlos Fuentes, called The Old Gringo.) Ironically, Bierce's decision to go to Mexico and fight in yet another war seems quite reminiscent of combat veterans today, who agitate on the home front for the battle-fueled adrenaline they can't help missing when they're back.  If you haven't taken the opportunity to acquaint yourself with Bierce's dark humor and realistic depictions of war (as a combatant), do yourself that favor.  And in the meantime, I'll leave you with one of the funnier quotes I've seen in a while, courtesy of the one and only Ambrose Bierce -- "War is God's way of teaching Americans geography."

Editor's Note: Thanks to Chris Lombardi for reminding me this week of the singular, terrible beauty of Bierce, and encouraging me to read his devastating battle account -- "What I Saw of Shiloh" -- which concludes with the highly memorable line about the life that he "should have thrown away, at Shiloh."  Yikes.  He gets it.

Find the Cost of Freedom, Buried in the Ground

It's an old Crosby, Stills & Nash song, by Steven Stills. Many of us who were there in the 70s still remember the words. I know I can recite them from memory: "Find the cost of freedom, buried in the ground. Mother Earth will swallow you; lay your burdens down."

Tomorrow is the Fourth of July.  Not only my favorite holiday the whole year through -- sorry, I'm a New Englander, we're just born that way -- but also another opportunity - along with Memorial Day, and Veterans Day - to stop and honor the service of those who sacrificed their lives for freedom, or at least, responded to what they saw as the call of duty that they responded to, while others did not. Those whose blood was shed on American soil -- in Lexington, Massachusetts, in the Revolutionary War -- and also, more recently, in the jungles of Vietnam, in the mountains of Afghanistan and in the sands and urban jungles of Iraq.

I'm thinking today about censorship -- and the power of an image to convey, in a single instance, what those of us who labor over our words perhaps never can.  The picture, they claim, is worth 1,000 words -- perhaps because it communicates, in an instant, across barriers of language, space and time -- what human beings instinctively understand, nonverbally.  With war: that there is a price; that it is never really glorious; that those who give their lives often do so -- as the poet W.H. Auden wrote about the famous art masterpiece, the "Fall of Icarus," by the Dutch painter, Brueghel -- in a depressingly inglorious context:

"About suffering they were never wrong,

The Old Masters; how well they understood

Its human position; how it takes place

While someone else is eating or opening a window or just walking dully along...

If you don't remember the Greek myth of Icarus you might need some refreshing.  He's the pre-Wright Brothers son of Daedalus, whose father built him a pair of wings, in order to take flight and escape from the island of Crete.  But the father glued the wing feathers in with wax, and then warned his son not to fly too close to the sun (probably without explaining actually why.)  Icarus partially succeeded in his goal -- he was able to fly, but in flying, did get too close to the sun -- at which point the sun's rays melted the wing feathers' wax and he literally dropped out of the sky, into the ocean -- having succeeded in his fabulous quest and also painfully failed, all at the same time.  That's not the parallel with the armed forces: the parallel worth drawing here is that sometimes death on a glorious "mission" turns out to be a most pedestrian thing, and the rest of us, unless we're apprised of it, don't even notice or celebrate.  On a deeper level, it brings up the question: as Americans, how exactly do we "support the troops," if we're not even really aware of what they're up against?

Unlike Vietnam, where grainy black and white news footage of U.S. soldiers fighting and dying in foreign jungles was often watched during dinner, with Walter Cronkite narrating -- in Iraq and Afghanistan, we're reduced to very little coverage and certainly not much that could "upset" our "overly tender sensibilities."  No flag-draped coffins being offloaded at Dover Air Force Base, instantly communicating that for every loss in combat there's a grieving, distraught family and a hole in the community, left by that veteran, that will never be filled.  Even those, like me, who don't exactly excel at math -- we're more than dimly aware that for every servicemember KIA -- or killed in action -- there are scores more wounded and disfigured for life -- emotionally scarred (invisibly) as well as visibly.  The human costs are staggering: those are daddies and mommies, sons and daughters, brothers and sisters, employees and employers who come home different: maybe unable to work, maybe unable to function - initially or long-term; maybe unable to take care of their families while they struggle with their own wounds of war.  This is the human cost of war: it exists whether we are personally dialed in to it and aware of it, or not.  It is, to use the words of Hedley Peach, a "generic effect of combat."

And while the news media gives scant coverage to what is happening in the conflicts in Afghanistan and Iraq, as surely as the hands of our clock tick daily the minutes and the hours, somebody's sons, daughters, brothers, sisters, fathers, and mothers are dying, and being injured -- somewhere.  We can be for or against the wars -- forget that noise for now -- but at the very least, we ought to be for the veterans.  And their families.  If what happens is fully what they signed up for: so be it.  I'll say this for myself, if no one else: They're better people than I am.  If it's not what they bargained for: even more reason to feel compassion for what they're going through.  But here's a pretty elementary principle: if we don't see it, we can't grasp it -- and we move on with our lives as though nothing were really happening.  No coffins at Dover? No bodies on the news?  I guess this war isn't really costing that much in human terms after all...it's just another blip on our radar, hardly making a difference among the rest of the pronounced concerns of our lives and welfare.  Except that it IS happening -- and men and women are dying, and being injured, often grievously -- and we're, generally speaking, like the villagers in the Icarus poem, above (read the whole thing) pretty unaware of how that affects us, or if it even does.

And THAT is where journalism comes in, and photojournalism -- to convey in a single image, what dozens of column inches can barely touch.  A single image that resourcefully, potently conveys the reality of life and death on the knife edge, on the tip of the spear -- somewhere around the globe, and challenges you, me, us -- the viewer -- to say that it matters, and that we finally understand.

Maybe that's why in every craptastic Third World-ish revolution, they always kill -- um, that would be the military who does the killing -- the intelligentsia -- the artists, the poets, the thinkers, the intellectuals -- first.  Because I guess if you even goad the populace at large to think, why, you're a highly dangerous individual, and should be stopped -- before you can do any more harm (I mean, good.)

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Want a riveting image, that "stops the presses," and conveys for all time the intrinsic truth -- or at least, one powerful truth -- about an experience?  Turn to a photojournalist.  I've read more words than I can think of in my time, but if you want to know what I remember -- it's the images, often Pulitzer Prize-winning, from the eras of our shared experience.  Vietnam? It's the naked young girl, covered in Napalm, running from her burning village.  (We dropped the Napalm, btw...) Famine in Africa?  It's the buzzard, waiting for the tiny dark baby with its protruding ribs to just "hurry up and die, wouldja?!" so the buzzard could eat it.  (The photographer who shot that amazing scene, and won a Pulitzer Prize for it, later killed himself -- perhaps because those who witness tremendous suffering, also suffer tremendously themselves.)

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I'm not going to say who it is, because -- call me a fatalist -- I don't want to wake up tomorrow and find out that he's dead.  ESPECIALLY not on the Fourth of July -- that would be offensive in the extreme.  But the other day, some well-known and ridiculously good photojournalist blogrolled me -- stuck a link to this blog on his blog -- and I checked it out, to see what his stuff was like -- and of course it was riveting.  He's an embedded photojournalist in Iraq, or was, I should say, until the Marine brass apparently got fed up with him, and summarily pulled him out of his embedded assignment and out of the country.  His only offense, from the sounds of things?  Shooting the aftermath of a suicide blast in Ramadi -- you know, the Anbar province -- the Sunni triangle -- the previous hotbed of violence in Iraq -- which if we're to read the mainstream media, why, all that has calmed down considerably from a few years ago, and there's hardly anything brewing there at all.  Well, except for the lives of scores of people who died there, INCLUDING MARINES, in a suicide bombing just last week.  This guy documented it -- as sensitively as one could, given the horrific nature of the scene -- and he expressed the emotional toll it was taking on him, as no other experience had.  And somebody in the Marine Corps upper echelons took offense at what the rest of us call -- oh, I don't know -- the First Amendment -- and took steps to pull him out of there, on the double.

Let's HOPE the guy lives long enough to evacuate safely.  Really.  And then let's hope he still gets to show what he shot, at great personal cost -- because some of the rest of us (it's a refresher course: we're called Americans) want to actually SEE the cost of freedom -- in a way that those of us who don't serve, don't know; and those of us who do, and did -- know only too well.  It's only fair.  If we sanitize the living daylights out of these wars -- for what? -- not only will the American public not "get" the tremendous price paid by those serving AND their families; they won't be as compassionate to the same people afterwards as they need to be.  It's in all of our best interests to actively fight for, and preserve, the freedom of the press.  And that means photojournalists, who document war's horror, sufferings, and triumphs in a way no print journalist could ever begin to approximate.

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For my part, when I saw the photos in question the other day, I had myself a good, therapeutic, and instantaneous cry -- not just for the crumpled bodies of THOSE Marines on the ground -- he was subtle, nuanced and concerned enough not to show their faces, or anything else that identified them -- but for all the others I knew and knew about, who'd fought, been injured, or died there -- or returned home, not quite as intact, in body or soul, as when they'd left.  To deny us, as Americans, the chance through images like this to share the plight of those who are fighting on our behalf elsewhere in the world, is to deny us the chance to share what servicemembers are going through; and to deny them the chance to know that somewhere out there are people who "get," admire and respect the tremendous price they've paid through their service.

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The Marine Corps, which wants to sign more patriotic young sons and daughters up to fight, apparently thinks that by constraining the version of what reality is to just a portion of the whole will keep them happy and us in the dark, and people like this brave guy, the photographer, well, in complete limbo.  Little do they know that the patriots will still fight, but the rest of us could use an education course in compassion, sensitivity and yes, tenderness for those who've fought in battle, that only comes through expanding our horizons, and by facing the whole truth of what they're really going through, as combatants. Don't sugar coat the truth: everyone who goes to war comes back changed -- that's just how it is.  Let's develop a compassion and an understanding for what they go through, not sweep it under the rug.  The death and injury of those with whom they serve is often the most scarring aspect of combat there is.  Just ask those who've never been the same since.

So especially on this Fourth of July, as one extraordinarily talented photojournalist sits in limbo, let's hope still alive, ripped out of the fight for no other reason than that he was getting a little too close to home in showing us what war is really like -- I'm appalled to think that as Americans, we're not being trusted with the whole truth, when it's expressly the whole truth that we need, as Martin Luther King once said, to set us free.  We need to know the human costs of these battles we're in.  And suppressing the images of that just harms our servicemembers and their families, and cripples the compassion of us as a people.

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Until I looked it up just now, I didn't realize that Crosby, Stills and Nash song had other lyrics.  Apparently it does.  Besides the chorus (above), which I remember so well, there's another verse as well:

Daylight again, following me to bed
I think about a hundred years ago, how my fathers bled
I think I see a valley, covered with bones in blue
All the brave soldiers that cannot get older been askin' after you
Hear the past a callin', from Armegeddon's side
When everyone's talkin' and no one is listenin', how can we
decide?

On the behalf of all those "brave soldiers that cannot get older," could we at least not suppress and crush the efforts of those who are trying to get us to see the whole truth?  What truth is that, you may ask?  The very cost of freedom, buried in the ground -- in Iraq, in Afghanistan, and in Vietnam beforehand. Godspeed, Z.  You are a witness on ALL of our behalf, to the price that war really exacts, on those who serve in it.

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

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

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

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

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

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

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

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

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

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

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

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

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

The Double Whammy: Women Combat Veterans with PTSD and Military Sexual Trauma

What's blowing up right now -- on the Web -- in terms of searches, within combat trauma and PTSD: definitely this one. People, the VA included, are looking for resources on treating women combat veterans who are victims of Military Sexual Trauma (MST) (see our index to entries discussing that, linked here). 

That means one of two things (prediction coming): either there's a scandal brewing, and about to hit the news, on this topic; or, the VA and others are fairly well bereft of resources and wondering how best to treat sufferers of this problem, who are apparently reaching the VA in greater numbers.  (One possibility: news items like this that show studies recently have shown an unsurprising but nevertheless unfair disparity in care between men and women veterans.)

Unfortunately, this is another case where civilians have a better situation going for them than the troops do.  In the civilian world, women can take their employers to court for providing a sexual harrassing or otherwise hostile work environment, and their victories in this arena put other employers on notice not to go and do likewise.  Sadly, the troops have no such protection.  It's completely a double whammy: combat trauma AND trauma from rape or other sexual crime.  Women servicemembers who've been affected by it say that in their minds, predominantly, the military sexual trauma is even worse than the PTSD, though they often occur together. 

It's clear we don't have a handle yet on treating PTSD; unfortunately, PTSD concerns even more people; and MST is probably further down the list of where resources are focused right now.  But whether through growing public awareness, better reporting, or for whatever reason, if searches are any indication, the VA is in a quandary about how best to treat MST, and even who the experts / what the resources are.  We wish them, and particularly those who have been injured and mistreated in this manner, all the best, and hope the situation resolves positively, and quickly, for our women veterans, who have been doubly injured.

PTSD, Puppies and Misplaced Values - We're Having the Wrong Conversation, America

Now that media coverage of SSgt. Travis Twiggs -- the five times-deployed Marine and gen-u-ine American hero who killed himself recently after a protracted and unsuccessful fight with PTSD -- has safely faded from view, America can go back to talking about what really interests it - like the Marine tossing the puppy off the cliff in Hawaii.  Here's a great quotable quote from Kathie Costos, a senior chaplain with the International Federation of Chaplains and a longtime, tireless advocate for veterans with PTSD, both personally and professionally on her blog, WoundedTimes, linked here.  After noting that a mention of the news update on "that jerk" with the puppy toss sent blog traffic sky-high, Costos said, most quotably -- "I hate the fact a puppy toss gets more attention than a Marine killing himself because the DOD and the VA won't do what they are supposed to do."  Amen, sistah.  (I don't believe that she's talking about the Twiggs case there, specifically, but just in general.)

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On this blog here, other than news about Travis Twiggs, which people were searching for because they cared about him, what really sends the hit meter aflying is any mention of THTIOKARR -- The Hotness That is Otherwise Known as Rudy Reyes -- who I mention from time to time only because, other than the obvious (hotness!!!), he seems to be an interesting amalgamation of "yin" and "yang" -- the reflective, centered, holistically-minded, nevertheless deadly warrior.  (Sort of the Bruce Lee Lite for our generation, or if Bruce Lee were a veteran, that sort of thing.)  That gives me hope that he's processing his own stuff, whatever that may be, from combat in as effective a way as possible, and being somewhat of a guiding light to others who have shared his experience.  On the other hand, I'm pretty sure people are just searching for photos of Rudy Reyes -- and where they're coming from is often fairly entertaining (defense installations everywhere, and multiple foreign countries, as well as our own.)  I enjoy learning news about Rudy Reyes, however faint, as much as the next person; or cringe over more news about the deranged puppy-tosser, but here's some veterans news we actually SHOULD care about, and it's happening NOW, and it affects us all:

From Brian McGough, at VoteVets, quoting Anne Weismann, general counsel for Citizens for Reponsibility and Ethics in Washington [CREW], in a blog entry linked here:

Today, [Citizens for Responsiblity and Ethics in Washington] CREW received a truly remarkable response from the Department of Veterans Affairs (VA) to its Freedom of Information (FOIA) request for documents relating to the VA’s abhorrent practice of under-diagnosing PTSD in veterans to save money. According to the VA, CREW is not entitled to a fee waiver -- meaning it has to pay for the costs of finding and copying responsive documents -- because there is no longer any public interest in this issue! Ignoring the wealth of news articles triggered by CREW’s and VoteVets.org's release of an internal VA email and the congressional hearing that release prompted, the VA claims that any records CREW requests “would not reveal anything new.”

(Those VA emails are at the heart of a Federal court case in San Francisco, put on by two veterans' rights groups suing the government over better care.  The judge in the case certainly seems to think they're relevant -- perhaps there are more, and that's why the requests were spurned.  Hey, can they even DO that?  They shouldn't be able to...)

But those don't seem to be the topics we're "alarmed" about -- how PTSD from combat trauma can be so bad it can kill you, and how the healthcare system in place to tend to veterans when they come back needs to do a better job of fully taking care of them.  No, instead we're searching for what amounts to celebutainment, and leaving the weightier matters -- for whom? If not us, who? It better be us, and all of us -- there isn't actually anyone else but us who oughta be caring, and who it concerns.  You don't have to actually put on combat boots to "get" that veterans are being underserved, particularly in the area of healthcare (TBI, PTSD, MST) and benefits (foreclosures! the GI Bill), and that it's up to us to care enough about it, that we do something about it, as a nation.  We CAN do that.  Otherwise, the note scrawled on the white board in the photograph, above, in Iraq, is really going to be our epitaph.  America isn't at war -- we're at the mall.

Editor's Note: Sign the petition for the new GI Bill, here. Love the slogan: "We sent them to war.  Why can't we send them to college?"  Why, indeed.

Israeli Military's Proactive Plan for Identifying and Treating Soldiers Who Have PTSD

Here in the U.S., in our usual myopic way, we can get bogged down in the news about returning servicemembers with combat trauma and PTSD and forget just how many other countries in the world have struggled with this problem as well, and often found their own solutions.  Internationally, Japan, Israel, Australia, England and Canada frequently search the Internet for news about who's doing what, and what's working, for treating PTSD worldwide -- according to data from Google's analytical trends.  Today, the Jerusalem Post has an article about how Israel's Defense Ministry is about to unveil a plan for evaluating and treating soldiers systematically who have been exposed to PTSD as part of their military service.  (The article in question is linked here.)  Their expectation is that 2,500 Israelis suffer from PTSD, in a country where military service is compulsory, and conflicts in the region frequently boil over into sustained violence. 

The significance of the Israeli announcement is that the soldiers will be treated according to a "set psychological and medical format," meaning systematically and methodically.  Their understanding is that PTSD treatment succeeds better if initiated earlier, so evaluating all soldiers soon after military service will increase the chances of favorable treatment outcomes.  According to the article, three years ago the military started thinking through how to create a protocol that would involve every soldier, and optimize chances of finding and treating PTSD.  The protocol was developed by Zeev Waisman and Dr. Dan Dolfin.

Two interesting comments from the article express a vision that the U.S. might be wise to emulate:

"A soldier who comes out of battle will immediately be evaluated and we will see what type of treatment he needs," Waisman said. "Nothing is done today in a regulated fashion and we want all treatment to be according to a protocol."

The process begins by inserting the soldier's profile into the system which will then offer several courses for treatment that could include medicines, psychological therapy, family therapy, sex therapy and others. Waisman said that the Ministry of Defense hoped to convince other organizations to adopt the new format which will be evaluated in two years.

Stateside, it's not even clear that the various branches of the Armed Forces share a similar protocol for identifying and treating PTSD -- most likely, they do not.  With far more servicemembers at risk for PTSD than the Israelis have, we could do worse than to imitate what the Israeli Defense Ministry is putting into action as a plan to deal with PTSD, and return exposed servicemembers to better mental and emotional health.

"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.

NYC's Urban Justice Center Offers Returning Veterans Legal Aid and Advocacy

The Veterans and Servicemembers Project of New York City's Urban Justice Center, linked here, offers, in their own words, "legal services and advocacy to a population often abandoned by the very system of government they defend in battle. Drawn increasingly from the poorest and most vulnerable communities in the country, past and present military personnel contend with poorly regulated recruiting tactics, unsafe working conditions, and an antiquated and overloaded disability benefits process. Often unaware of their rights and wary of challenging authority, they face especially daunting barriers to necessary assistance."

Furthermore, "At an individual level, the Veterans and Servicemembers Project provides legal training and representation on matters ranging from veterans disability claims to service discharge applications. The project also pursues systemic reform through litigation and advocacy in such areas as recruiting irregularities, workplace harassment, and inefficiency and abuse in the benefits application process. With the active collaboration of existing service organizations, it aims to provide comprehensive education and support for a population that, in a time of mounting war, promises only increase in size and collective need." 

Editor's Note: To learn more about this program, read the excellent article by Thomas Adcock, called, "Returning from War," originally published in the New York Law Journal, on February 22, and linked here.  If you're a lawyer who'd like to participate pro bono in helping veterans, click this link. 

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

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

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

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

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

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

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

More Combat = More Trauma, and More Chance of Developing PTSD, Study Shows

For anyone who's every wondered about whether troops' increased exposure to combat trauma results in greater chances of their developing PTSD, the answer is a definite "yes," according to a study released in the February issue of the Psychiatric Times, linked here.  The article from which excellent graphic (left) is taken is entitled, "Posttraumatic Stress Disorder in Veterans," and it makes the point that cumulative exposure to combat trauma predicts PTSD in a linear fashion.  Less exposure (fewer firefights) -- lower rates of PTSD; higher exposure (greater number of firefights) -- higher rates of PTSD.  According to the article, it really is that simple.

The article's authors cite an earlier published report of OIF (Iraq) and OEF (Afghanistan) servicemembers, and found high rates of exposure to both "traumatic situations and combat."  "According to the study, about 33% of soldiers in Afghanistan and 71% to 86% of soldiers in Iraq experienced a firefight. PTSD rates ranged from 6.2% for veterans of Afghanistan's OEF to more than 12% for OIF veterans. The risk of PTSD was found to increase linearly with the number of firefights (see graphic, above). Having been wounded, a condition previously found to be predictive of PTSD, was also significantly associated with PTSD. As is commonly found in patients with PTSD, rates of depression and alcohol use also increased following combat exposure."

When we think of tragic stories of what we can only assume to be PTSD-fueled incidents in the news -- the recent suicide of Marine SSgt. Travis Twiggs, the arrest of Marine LCpl. Eric Acevedo for murder, and others like them -- we should really stop to pause and wonder, how many times have these servicemembers been deployed, for how long have they been in combat, and to what have they been exposed (meaning, how many firefights)?  Twiggs, it turns out, had done four(!) tours of Iraq, and one of Afghanistan (earlier reports mentioned four total, but they were wrong); Acevedo had done three tours of Iraq by the time he was 22, including one that involved a horrific battle, where 10 members of his battalion died on a single day, and several others were wounded.  To not take the effects of their cumulative exposure -- what they saw, did, were witness to -- is just unconscionable.  We have a very love-hate relationship with the glory of serving in this country: we glorify our military heroes for their astounding feats of endurance (Brad Kasal, the Marlboro Marine, etc.), but we also equally unreasonably vilify them when they crack under the all-too-obvious strain.  It seems like what we need most of all is just the sober estimation: the more servicemembers have gone through -- and suffered -- the more we can expect them to have problems later on, with developing PTSD.  As noted Australian Vietnam War researcher Hedley Peach said in a slightly different context, what we're really looking at here is not something unusual -- it's the generic effect of combat.

Where Is Suicide Most Prevalent Among Young Males in the U.S.?

Forgive me for being naive, but I had no idea "suicidology" was such a sophisticated profession.  Such specificity!  Such granularity!  Such nice maps, even. (Thanks, Centers for Disease Control!)  Finding out who kills themselves nationally by type -- race, age, gender -- is seemingly pretty doable -- and if you know where to look, the maps already exist.  There's something called "the Atlas of United States Mortality," and it's a veritable treasure-trove online of useful and useable data. Here, for instance, is a map of where 20 year old white males, are most likely to kill themselves in the U.S. -- followed by a similar map for 20 year old black males.  Notice that, apart from some places in the Southwest, there's actually not much overlap between the two maps.)

Want that same data for 20 year old white women or 20 year old black women?  It exists, too. Not sure if anyone's done the Hispanic data yet, but if not, they should.  (All the above data is from the PDF, linked here.)  Want to find the same data about how many people use a firearm to commit suicide, mapped against a map of the United States?  Here it is.  Want to find the same information about those who die by motor vehicle accidents (among whom is a certain percentage of undisclosed suicides)?  It's here.

In an Op-Ed piece from the Boston Globe from August of 2004, Michael Craig Miller, M.D., editor-in-chief of the Harvard Mental Health Letter, talks about what he learned from doing his own suicide map of the United States.  (Ironically, he found that it coordinated roughly with political lines, but that wasn't his only observation, so we'll set that one aside for now, lest it inflame but not inform.)  He was surprised to see a roughly three-fold difference between high and low states, even after accounting for age and ethnicity.  Searching for the factors that might contribute to this, he speculated:

"Local and individual factors are important: personal loss, family conflict, economic travail and unemployment, the quality of the support system, and cultural or religious beliefs about death or suicide. Easy access to guns is risky for a vulnerable person.  Access to mental health services, on the other hand, reduces the risk of suicide, which is usually a result of mental illness. But stigma is an enormous obstacle to treatment. Most people with mental disorders fear a negative or patronizing response, even from health-care providers. The more severe their distress, the greater the dread of reaching out."

I'm interested in this whole topic because I'm trying to figure out how to plot the average age of military members in various states, and their ethnicity -- against their likelihood of committing suicide, even before combat -- to see if we can ascertain whether mental health services are adequate for returning and deployed military in those states.  This is pretty much a work in progress, and not the quickest thing I've ever done -- so bear with me over the next few days, as we find this out -- together.

One positive remark by Dr. Miller, concerning military efforts: "The US Air Force has recently achieved remarkable success in preventing suicide. In 1996, the leadership instituted a service-wide program to increase awareness of suicide risk factors and make resources available for treatment. High-ranking officers championed the cause, which helped reduce the stigma attached to seeking help for problems like depression. The result was a 33 percent reduction in the rate of suicide among Air Force personnel."

If this is true/has remained true, I'm curious to know whether the Air Force's program served as a model for the other services.  From the absence of any talk confirming that in the media, it would seem that it either hadn't or didn't -- either that, or no one saw fit to mention it.  (They have one of the lower profiles of the services in the OIF/OEF efforts.) Another possibility is that there just isn't that much coordination among the armed services on mental health issues, so each service is developing a program on its own -- the time-consuming, re-inventing the wheel kind of way.  I really can't speak to that, because I don't know anything about it -- but over the coming days, maybe we'll find that out as well.

Editor's Note: Dr. Miller's Op-Ed piece from the Boston Globe is linked here.

Montana's National Guard Holds Public Meetings on PTSD

Recently we wondered what National Guards in the various states with high suicide rates for males were doing, or not doing, about mental health screening for returning or deployed troops.  We found some (slightly) positive news: that the National Guard in Montana, which as a state has the highest rate of suicide for males per capita in the nation -- something we blogged about here -- perhaps in part because of their low population density, but nevertheless -- was doing something about it.  Throughout the month of May, they held hour-long meetings in the community to talk about PTSD, and show a half-hour video they'd made about its signs and symptoms.  The only problem is, of course, that the meetings were only an hour long -- and with a half-hour video as part of that, probably left slim time or attention for questions and answers and feedback.  Still and all, some time is better than no time devoted to this important issue, so we commend the Montana National Guard for trying.

The hour-long meetings were held the week of May 19th. Four separate teams of soldiers and airmen will be conducting the meetings, according to Col. Jeff Ireland, the director of personnel and manpower for the Montana National Guard. “We want to take this information to the people of Montana so that they understand what PTSD is and what they can do to help their friends, neighbors or relatives that may be affected by PTSD,” he explained.

“The Montana National Guard is dedicated to ensuring that all Montana’s Soldiers and Airmen are taken care of before, during and after a deployment in support of our state and nation. Our efforts are to reach out to the people of this state and get their help,” Ireland said.

The meetings schedule will include the viewing of a 30-minute video produced by the Montana National Guard about PTSD and its impact on service members and their families. In addition, a question and answer period will be held to get ideas and feedback from attendees.

The public was encouraged and invited to attend the meetings. For more information, contact Capt. Jeremy Hedges at (406) 324-3986 or visit the “Beyond the Yellow Ribbon” campaign on the Montana National Guard's website, linked here.

Does Suicide Data for Combat Veterans Match or Contradict Suicide Data by State?

Who knew there was such a thing as a "Suicide Map of the United States," but it stands to reason that such a thing exists, because the data it illustrates can be mapped.  (The map at left is rather old, but serves to illustrate the point.)

Each year, the United States, through the Centers for Disease Control (CDC) in Atlanta, collects data by state of how many people have killed themselves, and from this data can form a ranking of suicide rates by state and gender.  My question is -- do suicide rates among veterans follow the pattern previously set by state?  And perhaps more importantly, are the military installations in a given state (like the National Guard) aware of how prevalent suicide among young males is or isn't in their state, so they can react accordingly, and perhaps increase screening of veterans for suicide risk?

From 2005 data, collected by the CDC, the top states for suicide by males are ranked in the following order: 1) Montana; 2) Nevada; 3) Alaska; 4) New Mexico; 5) Colorado; 6) (tied for 5th place) - North Dakota; 7) South Dakota; 8) Idaho; 9) Wyoming; 10) Arizona; 11) Oregon; 12) Tennessee; 13) West Virginia; 14) Oklahoma; 15) (tied for 14th place) - Arkansas; 16) Utah; 17) Maine; 18) Kentucky; 19) Kansas; 20) Mississippi; 21) Washington state; 22) Missouri; 23) New Hampshire; 24) Florida; 25) Indiana; 26) Alabama; 27) Ohio; 28) Vermont; 29) South Carolina; 30) Pennsylvania; 31) Wisconsin; 32) Virginia; 33) Louisiana; 34) North Carolina; 35) Michigan; 36) Iowa; 37) (tied for 36th place) - Minnesota; 38) Delaware; 39) (tied for 38th place) - Texas; 40) Nebraska; 41) Georgia; 42) Maryland; 43) Illinois; 44) California; 45) Connecticut; 46) Hawaii; 47) (tied for 46th place) - Massachusetts; 48) New York; 49) New Jersey; 50) Rhode Island; and 51) District of Columbia.

The Minnesota National Guard has stood out for its proactive stance on reintegration services for returning combat veterans - we've blogged about their efforts earlier, here.  But according to the data above, Minnesotans males are 37th least likely in the U.S. to commit suicide. The New Hampshire National Guard has a program that's apparently a model for the nation -- we blogged about it earlier, here -- but New Hampshire males are 23rd least likely in the nation to commit suicide.  The Vermont National Guard has also taken proactive steps to help its veterans reintegrate successfully -- we blogged about that, here -- but males in its state are 28th least likely in the U.S. to kill themselves. 

How about the Montana National Guard, the Nevada National Guard, the Alaska National Guard, the New Mexico National Guard, the Colorado National Guard, the North Dakota National Guard, and so forth -- are they taking steps to educate their servicemembers at risk for suicide?  Ironically, as we blogged about it, here, in March of 2006, the Iowa National Guard -- and Iowan males are 8th in the nation, according to the above data, in suicide risk -- had  downgarded their mental health counseling for returning veterans from "mandatory" to "optional."  Let's hope they've since changed that and made effective screening mandatory -- along with all 50 other states.  Of the National Guards in the top six states at risk for male suicide mentioned above, only one -- Montana -- has any mention of mental health issues on its website.  The Montana National Guard seems to have been holding a series of public meetings in May for Montanas to help recognize PTSD in their returning servicemembers.  See that link, here.  A great step forward, at least for the Montana National Guard, in the state that has the highest suicide rate for men in the nation.

Data source: CDC's WISQARS website "Fatal Injury Reports," http://www.cdc.gov/ncipc/wisqars/; downloaded January 24, 2008.  Prepared by John L. McIntosh, Ph.D., Indiana University, South Bend, for posting by the American Association of Suicidology -- January, 2008.  (The American Association of Suicidology's website is linked here.)

The Killer Headache: Migraines, PTSD and Increased Risk of Suicide among Veterans, Teens

Remarkable scientific data first reported over a year ago -- which seems to have created nary a flicker of interest in the media, though it absolutely should have -- links veterans' experience of migraine headaches with likelihood of experiencing PTSD, depression and anxiety.  Similar research in teens -- and many combat veterans, after all, are barely out of their teens -- indicates that those who suffer migraine headaches most frequently are also at greatest risk for suicide.

In soldiers:

Soldiers returning from combat in Iraq who have migraine headaches are more than twice as likely to also have symptoms of post-traumatic stress, depression or anxiety than soldiers who do not have migraines, The study involved 3,621 United States Army soldiers who were given a health screening questionnaire within 90 days after returning from one year of combat duty in Iraq. A total of 2,167 of the soldiers, or 60 percent, completed the questionnaire. Of those, 19 percent screened positive for migraine headaches, 32 percent screened positive for depression, 22 percent screened positive for post-traumatic stress disorder, and 13 percent screened positive for anxiety.

The researchers found that 50 percent of those with migraine also had depression, compared to 27 percent of those without migraine. A total of 39 percent of those with migraine also had post-traumatic stress disorder, compared to 18 percent of those without migraine. And 22 percent of those with migraine also had anxiety, compared to 10 percent of those without migraine.

"Previous studies in non-military populations had revealed a higher prevalence of certain psychiatric conditions, such as depression and anxiety, among people with migraine," said study author Maj. Jay C. Erickson, MD, PhD, of Madigan Army Medical Center in Tacoma, WA. "We hypothesized that there would be a similar relationship between migraine and psychiatric conditions in soldiers. The precise reasons for such an association are not fully understood, but may be related to similarities in the mechanisms underlying migraines and some psychiatric disorders."

The study also found that those with migraine and depression also had more frequent headaches than those who had migraine with no depression -- an average of 3.5 headache days per month for those with depression compared to 2.5 days per month for those with no depression. The findings were similar for those with migraine and post-traumatic stress disorder.

"These findings should alert health care providers, especially those affiliated with the military or veteran health care systems, about the frequent association of migraine headaches and psychiatric conditions in soldiers returning from deployment," Erickson said. "We recommend that health care providers who evaluate combat veterans for headaches perform mental health screening in order to ensure that psychiatric disorders are identified and properly treated. All soldiers returning from deployment presently undergo mental health screening."

This research was presented at the American Academy of Neurology's 59th Annual Meeting in Boston, April 28 -- May 5, 2007. Full citation: American Academy of Neurology (2007, May 4). For Iraq Veterans, Migraines May Be Sign Of Other Problems. ScienceDaily. Retrieved May 30, 2008, from http://www.sciencedaily.com­ /releases/2007/05/070503075228.htm

For teens:

Teens who have chronic daily headache, especially those with migraine headaches, are at greater risk for suicide than teens who don't have migraines, according to a study published in the May 1, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology. Teens with migraine are also more likely to have other psychiatric disorders such as depression and panic disorder.

Reported in ScienceDaily, May 1, 2007.  Full citation: American Academy of Neurology (2007, May 1). Teens With Migraine At Greater Risk Of Suicide. ScienceDaily. Retrieved May 30, 2008, from http://www.sciencedaily.com­ /releases/2007/04/070430181213.htm

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.

Citizen Journalist Dad Uploads the Damning Ft. Bragg Barracks Video: "Ask Them to Fix This!"

A stunning video, shot by a returning combat veteran's dad, and uploaded to YouTube by him, shows the deplorable conditions awaiting his son in the barracks at Fort Bragg, North Carolina, after 15 long months in Afghanistan.  The screen capture to the left is a soldier plunging a clogged bathroom drain, on a bathroom floored filled with inches of standing water and raw sewage.  Ft. Bragg's living conditions, at least as shown in this video by a suitably outraged father, bring to mind those at Walter Reed, profiled by the reporting team at the Washington Post last year.  The Fayetteville Observer has weighed in with an article on the conditions at Fort Bragg, prompted by the release of this video, and they're asking for answers, too.  Do yourself a favor and watch what one citizen journalist did to document the conditions facing some returning military.  We are not remotely giving them the care that they deserve.  And it's shameful that public pressure has to be brought to bear, by videos like this, before conditions are improved for returning servicemembers. When you think of all the challenges they've been through, which are more than enough to process and decompress from, the last thing they need it to be "greeted" with hospitality like this.  If this is how we treat our returning soldiers, what hope can they have that we as a country really care about their welfare -- mental, emotional, physical and spiritual.  These pictures speak louder than words.  Watch the video, below.  The article in the Fayetteville Observer is linked here; with follow-up linked here, and three full days later (cough, cough) on CNN, linked here.  (It's great to scoop CNN on a blog ;-).  (Military.com has not covered it yet, but ideally they will, and soon.)  Over time, of course, we can expect to see follow-up, and damage control, and spin -- and eventually, one hopes, actual change.

Editor's Note: the video was uploaded by Edward Frawley, the father of a sergeant who served with the Army in Afghanistan, as part of Charlie CO 2/508 82n Airborne.  His son returned to the U.S. on April 13, 2008, and is living in the dilapidated barracks on base.

A Poem for My Father

Medic! Medic!

I wish I could yell, and someone would come,

But they don’t

I call in air support but the pilots are all stricken too

The infantry has gone into the bunkers

MIA in their own wars like yours …

Forty years after ...

Under a hundred starry nights … stained with blood

Comrades lost, in the winds of Battles gone

In a war over there, in the napalmed jungles

Where Agent Orange still stains the ground

A million screams now silent,

Except those in your mind, which will echo

For all time

We are alone

And we fight the war, together, after you’ve come home

Medic! Medic!

You were wounded in the Nam

Spiritually, wounded, for a country that has forgotten what you’ve done

And what was done to you

Medic! Medic!

Nobody to help us, just you and me

You are wounded, and I your son, a warrior too,

Help you carry on

Though I have never seen the jungles

I am there with you

Fighting a war

In jungles of PTSD, anger, fits of rage

Flashback ...

Incoming, again!

You duck into your psyche until choppers pass

Ones you hear, though we are standing here in suburbia

Guns firing, shrapnel flying,

Once again ... it happens often

We go on, me carrying you, and you wounded

Through the battle under the blood stained heavens

Fighting the war together, the one they forgot

The war you still fight, I fight with you

Medic! Medic!

© 2007 by Jeremy Hogan, photojournalist, son of Jerry Hogan, a Vietnam veteran with longtime PTSD.  The photo is of Jerry Hogan.  Used with permission.

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Editor's Note: April is National Poetry Month.  We're initiating it with this poem, written by a son about his Vietnam veteran dad's experience with PTSD.

Not an April Fool's Joke: Vietnam Vet Just Received Compensation for His PTSD Claim

The Wadena Pioneer Journal of Wadena, Minnesota, published a story recently, touting the eventual -- and I do mean, eventual -- "victory" of a Vietnam-era veteran receiving compensation for his PTSD.  That's the pioneering Eugene Foster himself, in the photo at left.  Minnesotans must be made of very strong, enduring stuff, because Mr. Foster has persisted through a two and a half year claims process, and three appeals, to achieve his victory of $65,000, or $2,527 a month from Veterans Affairs for the rest of his life, according to the story.  The article also quotes Mr. Foster as saying, "I don’t give up too easy...I come from a long line of stubborn people."  Good thing, considering the Vietnam war ended 33 years ago next month, and, at 64, Mr. Foster's life expectancy is just 15 more years, a number probably discounted further by years of poor health.  Ever alert for a touch of irony in these heart-breaking situations, I find it in this comment of his veterans service officer: "“The only thing I can say is the system works.”

Well, provided you're not in any hurry, I guess.  Mr. Foster had another claim out, according to the paper, for "continuing knee problems he said stem from a shrapnel wound he sustained during the Tet Offensive in January, 1968."  But, he "dropped that claim during the process of receiving his PTSD settlement, he said."

Like the narrator in Langston Hughes' poem, "Mother to Son," who lamented that "life for me ain't been no crystal stair," Mr. Foster has had, arguably, more than his share of suffering and pain in this lifetime,  much of it thanks to his Vietnam experience, and his attempts to cope with that through his own methods and means.  The article in the Wadena Pioneer Journal is brief, but it mentions about a dozen difficult life experiences.  A brief catalog of this veteran's hard luck life: the Vietnam War itself, PTSD, his Vietnamese fiancee killed by the Viet Cong; the shrapnel wound; the knee problems; the lifetime spent self-medicating his depression with alcohol, till he kicked that habit; high blood pressure; and getting around in a walker and a wheelchair, in an apartment that had stairs.   Thankfully, Mr. Foster persisted, and now the small settlement will allow him to move apartments, and ideally be able to find a "two-bedroom condominium with all new carpets, floor heating and dishwasher..."  Small, reasonable goals for someone who served his country, honorably.  As Mr. Foster cautions others veterans, "Fight, don't give up."  Veterans "deserve what compensation they get." (We won't argue with that.  They even deserve it in a timely fashion, and enough to live on.)  As he says, "A lot of people should be compensated who don't have it."

Editor's note: Click this link to find the article.  The original article on the Wadena Pioneer Journal's website has some technical difficulties accessing it.

Behind the Bloodshed, Some Backstory

Another day, another lurid headline.  A Marine Lance Corporal in Texas, recently returned from three back-to-back tours of duty in Iraq, and allegedly suffering from PTSD, breaks into his former girlfriend's home, stabs her to death and then waits, "covered with blood and looking dazed," in the parking lot for police to arrive and arrest him.  On the surface, another brutal domestic violence story, with a very tragic ending.  Behind the headlines, though, more questions than answers about troops' after-care, and whether ethnicity (the Marine in question is Hispanic) plays or ought to play a part in how PTSD is diagnosed and treated.

First, some facts.  Marine Lance Corporal Eric R. Acevedo, 22, was arrested over the weekend for allegedly murdering his former live-in girlfriend, in Saginaw, Texas, a suburb of Fort Worth.  The Fort Worth Star-Telegram has been covering the story, and it's typically gruesome, but it's also a tragedy for all concerned. The victim, who was a single mother; the alleged perpetrator, who will likely do substantial prison time; and both people's families -- the 10 year old girl who now grows up motherless, as well as Acevedo's family, who believed he was struggling with PTSD, but was sent back to Iraq.

There are several items that stand out immediately from this story.  One is the obvious: three tours in Iraq by the time you're 22?  Wow.  That's a lot of compressed heavy living right there, at a very young age.  (Acevedo joined the Marines just a few days after graduating from high school.)  Another is obvious from the photos that run with the story.  There's one of Acevedo in his dress blues, looking fit and tanned and what they call in language of the personal ads, "height-weight proportional."  Then there's his booking photo, where he looks, oh, about 44, not 22, and seems heavy, puffy and bloated.  It doesn't even look like the same person.

Then there are the comments from his family, which underscore that to them, Acevedo wasn't the same person anymore.  (Granted, those have to be taken with a grain of salt, because, after all, they're coming his family.  But still, listen to what they have to say.)  The following quotes are from the Star-Telegram.  His aunt: "I know he was a good soldier. I just don't know what happened. When he went in, he was so proud. When he came out, he had so many problems. I don't know what happened to him."  His dad, who feels that his son has never been the same since his second tour of duty in Iraq: "I gave him to the government nice and healthy, and the government returned somebody who is capable of doing something like that...I'm out of words as far as to just how sorry I am."

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In the Marine Corps, Lance Corporal Acevedo did three tours of Iraq over four years' time, returning for the last time 13 months ago, and leaving active service to go into the Individual Ready Reserve.  According to a Marine spokesman quoted in the article, Acevedo had been stationed at Twentynine Palms, California, "and was deployed for about seven months in 2004 and again in 2005-06, and for six months in 2006-07." The Marine spokesman says Acevedo was "a good Marine," and received various medals for his service, including the Marine Corps Good Conduct Medal, Navy and Marine Corps Achievement Medal, Iraq Campaign Medal, Global War on Terrorism Service Medal, Global War on Terrorism Expeditionary Medal, National Defense Medal and Combat Action Ribbon.

But according to at least his parents, something drastic happened to Acevedo between his second and his third tour of duty.  Says his father, "I was very proud of him. He served well over there. He never complained.  But when he did this last tour, he was feeling kind of like he didn't really want to go because of the nightmares and stuff he had had from the second time. My wife tried to stop it over medical issues. They still sent him off."

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Because it's always worthwhile to find out if there's any backstory worth knowing, I did a little digging.   What had Acevedo experienced that might have caused the change in his behavior?  Deep within the archives of the Marine Corps' own website, there's a wonderful, even iconic photo of a grieving Lance Cpl. Acevedo, grasping someone who's identified only as a young relative in an emotion-filled hug.  The occasion is a memorial service to commemorate the 13 lives lost by Acevedo's battalion, 10 of them on a single day in Fallujah, making that one of the largest losses of American life in the Iraq War.  Acevedo served on that tour with the 2nd Battalion, 7th Marine regiment, also known as "the War Dogs."  On December 1, 2005, ten of his brother Marines died in an IED blast while out on patrol.  While all lives lost are precious, and close-knit groups like the Marines feel every loss deeply -- one wonders, is it harder to endure large losses at once, than multiple losses, individually?  Has this even been studied?  (Seemingly not.)  One thing is sure: studies show that the more traumatic incidents a person is exposed to, the greater the likelihood that they will develop PTSD.

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From what his father says, reported by the Fort Worth paper, Lance Cpl. Eric Acevedo wasn't coping so well anymore.  Six months ago, a military doctor "diagnosed his son with post-traumatic stress disorder and placed him on medication that seemed to calm him down."  But there's some dispute about whether those facts were strictly true. The paper also reports that, according to records kept by the Dept. of Veterans Affairs, Acevedo had "not enrolled enrolled in the VA North Texas Health Care System or applied for any VA benefits."  So time will tell which of these stories are true.  But one thing is certain: If Acevedo really did have diagnosed PTSD, at the end of his second tour (after the Fallujah incident), it wasn't a good idea to send him back so quickly for a third deployment, if at all.

And then there are other implications.  The multiple tours and long deployments, with insufficient breaks in between tours, all recent news reports indicate, seem to be wearing troops out, not just the Marines.  (See discussion in today's Military Times.)  Even the Dept. of Veterans Affair's own data shows that when it comes to PTSD (this data is based on Vietnam veterans), "higher levels of war-zone exposure tend... to contribute to a higher degree of symptoms."  (Longer tours and more of them certainly constitute higher levels of war-zone exposure.) 

In addition, the same study showed that "race/ethnicity appeared to be an important risk factor, as African-American and Hispanic Vietnam veterans tended to report more mental health and life adjustment problems. For PTSD in particular, Hispanic male veterans had the highest prevalence rate..."  Not to argue for preferential treatment for various ethnic groups, but, shouldn't the implications of this data at least be acknowledged?  Maybe PTSD is affecting different people differently, even if we don't know all the reasons why yet.  (There are other implications, too, about medications that purport to solve some problems while increasing risks of others; and the jagged line where domestic violence and PTSD can intersect, with often tragic consequences -- but we'll have to save both those discussions for another time.)

Editor's note: The Marine Corps story about the memorial service for Acevedo's battalion is linked here.  The list of Marines who died on 12/1/05, according to Marine Corps sources, are as follows: Staff Sergeant Daniel J. Clay, 27, of Pensacola, Florida; Lance Corporal John M. Holmason, 20, of Suprise, Arizona; Lance Corporal David A. Huhn, 24, of Portland, Michigan; Lance Corporal Adam W. Kaiser, 19, of Naperville, Illinois; Lance Corporal Robert A. Martinez, 20, of Splendora, Texas; Corporal Anthony T. McElveen, 20, of Little Falls, Minnesota; Lance Corporal Scott T. Modeen, 24, of Hennepin, Minnesota; Lance Corporal Andrew G. Patten, 19, of Byron, Illinois; Sergeant Andy A. Stevens, 29, of Tomah, Wisconsin; and Lance Corporal Craig N. Watson, 21, of Union City, Michigan. All 10 Marines died December 1, 2005, from an improvised explosive device while conducting combat operations against enemy forces in Fallujah, Iraq. All 10 Marines were assigned to 2nd Battalion, 7th Marine Regiment, 1st Marine Division, I Marine Expeditionary Force, Twentynine Palms, California; During Operation Iraqi Freedom, their unit was attached to 2nd Marine Division, II Marine Expeditionary Force (Forward).

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.

Helping Families to Recognize Veterans' PTSD

The Northern California news website, InsideBayArea.com, has a good article in today's edition, entitled, "Families Can Help Spot Vets' PTSD."  Click here for the link.  The article quotes Byron J. Wittlin, M.D., Director of Mental Health Services at the VA Clinic in San Bruno, CA.  Says Dr. Wittlin, "I think it's crucial for (military) family members to be aware of the potential mental health problems of their loved ones."  It's great to see the VA doing outreach to family members, who are in a unique position to see for themselves veterans' difficulties readjusting to life after combat.  (For a very good video about veterans, PTSD, and readjustment issues, click this link to an earlier blog post, where we highlight the "PTSD and Veterans: Beyond the Yellow Ribbon" video put together by the Norfolk County District Attorney's office, in Canton, Massachusetts.)

The article covers some important topics, including typical PTSD symptoms, veterans' reluctance to seek care, the perceived stigma surrounding mental health issues, and whether or not a loaded gun is wise to keep in the house.  Wilkins offers some hope about PTSD, that sufferers can get better.  And while he acknowledges that it takes a trained expert to actually diagnose PTSD, family members can play an important role in moving that process along, and encouraging their veteran to get help.  According to the article, "We encourage family members to be supportive, to mainly listen," Wittlin said. "And if they feel the vet needs some help, to call the VA and to refer them into us. This is really a complicated problem. And in our system, we have a lot of experience. And this is one of the services we want to offer."  Excellent news, for veterans and their families.

Editor's note: The Dept. of Veterans Affairs facility in San Bruno, CA is linked here.

VA Head Peake Talks to Veterans at Local VFW

The tiny Salisbury Post, from Salisbury, North Carolina, has an article in last Friday's paper about the current VA Secretary, James Peake, M.D., meeting with veterans at the local VFW, along with their U.S. senator, Richard Burr.  Click here for the link.  The story is entitled, 'Old soldier' vows to take care of veterans, deal with VA claims backlog," and it's an interesting story to read, mostly from the point of view of wanting to remember, for posterity, what Peake is saying his point of view is regarding veterans.  The article quotes him as saying, among other things, "The idea is to get out and really understand what's going on with the veterans, and how well we're taking care of them."  While that's a laudable sentiment, so far as it goes, it and other quotes like it make Peake sound an awful lot like he's currently on a "fact-finding mission" at the moment, talking with veterans to see how their care is going, and how they and their families feel about it.  And if that's true, it's "nice."  It's a little bit like childhood memories of school principals or maybe even superintendents walking around the lunchroom, asking elementary schoolers who basically had no real vote in the process how they liked what the cafeteria was serving. Somewhat of a pr move, even at the best of times, and if the school were in fact on fire, really not the best use of time, or conversation to be having.

In the present case, it seems that the facts of what's been going on with veterans care have been more than adequately laid out for all to see, and that the process of triaging out the worst problems and starting with fixing them could already be underway.  So I'm not really sure what to think about this.  I want to believe it's sincere, but talking with a few veterans and VA staff at a single VFW doesn't really constitute aggressively going after change.  It's fair to say most of us who've been following this topic with any regularity already have a pretty clear idea of what the issues are.  And here's the thing: there's basically NO TIME TO WASTE, while veterans are dying by their own hands, or taking forever to get in and get appointments to be seen, etc.  There's an old saw in the legal biz that "justice delayed is justice denied," and the same is true here.  The difference between being seen or treated and not can mean the difference between life and death to some veterans.

I understand and sympathize that there's a public relations aspect to any job this big, and Peake is very much a political appointee, not an elected official.  However, to the extent that we can dispense with the fireside chat and start triaging the mess we're in, so much the better.  The public relations aspect might be better left for a window of relatively little activity, in other words, when things seem reasonably fine.  If things are pretty much under control already, then great, get out there and met the vets, and get the scorecard on how things are really going.  But when the scorecard is already in the paper, and is already clear for all to see, it seems like it's more likely a form of not taking things seriously enough.  If my car is up on blocks in the yard, it's really not time to get it detailed, or fuss about how long it's been since I've washed it.  More serious issues are afoot -- with all due respect, let's get ON with it.  There is no shortage of work to do, and veterans to be served, who, with their families, are waiting.

Military Chaplains Carry, and Comfort in, Grief

Yahoo News has a good story today about the role of military chaplains in honoring the sacrifices of servicemen and women who have died in combat.  It profiles the experiences of four military chaplains, who've served in Vietnam, Afghanistan or Iraq.  The article is called, "Chaplains Salute Each of the Fallen," and it's linked here.  As the article points out, "Military chaplains don't carry weapons, don't engage in combat, and yet they know as well as any the human cost of war," and this "human cost" very much takes its toll, even on those most qualified by their faith, so to speak, to offer comfort and support.  Said one chaplain, quoted in the article, with each subsequent death, "you lose part of yourself that you're never going to get back."

Those of us who were raised on M*A*S*H have a probably very skewed view of what chaplains do in wartime, but there's no question that they're a special breed -- needing to be there to offer words of comfort and support to the troops, in the midst of struggling with their own very real grieving over loss.

In related news, congratulations are in order to fellow PTSD blogger, Kathie Costos, for just last week passing the test to become one.  With her extensive, 25 years of personal experience caring about combat trauma and its effects on the troops, as well as her personally offering comfort to those who suffer, she should really be one sensational chaplain.  Kudos to her for a wonderful accomplishment.

If You Build It, They Will Come: Vets and Mental Health Services

I happened to hear an item of interest about veterans on local San Francisco public radio station KALW as I was driving around doing errands.  The show was "Cross Currents," and the story was about going to the VA Medical Center in San Francisco, and how most of the patients are older, gray-haired types from the Vietnam era, and how there are very few veterans showing up from the wars in Afghanistan and Iraq. Even the staff members are trying to figure out why, and they have several theories, including that soldiers don't always realize they're eligible to be treated by the VA, and that those with compound injuries are treated in Palo Alto, CA instead, because it is one of the VA's four polytrauma centers in the U.S.  They were saying that most of the injuries seemed physical; yet, when the opportunity for mental health services were offered, a stunning [to me, maybe also to the providers] 98% of the veterans were interested in a referral.  No transcript has been posted yet on the probably underfunded KALW site, but the reporter's name was something like Joy Corneule.  I'm interested in seeing if anyone can substantiate that figure, because that is plenty interesting indeed. (It also seems abnormally high.)

It would be significant for all kinds of reasons, including increasing public awareness of what veterans have undergone, and decreasing stigma about mental health issues in general, including combat trauma and PTSD.  It also brings up a logistical dilemma: have fewer veterans been taking advantage of mental health services simply because those services have not been offered clearly enough, or offered at the wrong time (i.e., too close to homecoming, when troops want to just back together with their families.)  We've seen from Vietnam that veterans often don't realize they are suffering from PTSD until many, many years later.  Ideally that cycle time will be cut down considerably with current veterans, because there's much more public discussion about the topic.  However, there still may be improvements that need to be made regarding how and when services are offered to veterans, and possibly offering these services at several intervals is best, with clear communication about their potential usefulness, and peer support from other veterans who have successfully undergone the same types of treatment.

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.

"Shattered Soldier" - the Artist's Description

John Paul Hornbeck says his "Shattered Soldier" sculpture took about 500-600 hours to build, and probably cost at least that much in supplies.  "I went for realism," he says, "I wanted people to feel the psychological/emotional impact of being a soldier with PTSD."

The sculpture, shown here partially dismantled for shipment, head removed, was fabricated from an assortment of (inert) grenades, 50 caliber bullets, shrapnel, magazine clips, mini bombs, tank shells, mortars, and bomb fragments, for realism.  Hornbeck says he's spent hundreds of hours as a child with his father, a Vietnam veteran, at the VA for treatment, listening to the stories of his father's generation of veterans, telling stories about the Vietnam war.  Hornbeck himself served in the Army.  He says, "Many soldiers have stories about a piece of shrapnel they carry in their limbs.  That is why I used shrapnel to be part of the limbs in designing my soldier."

The sculpture is life-sized and at least as heavy as a real soldier.  Hornbeck says that it includes "at least 200-300 .50 caliber bullet tips that were tumbled, cleaned, drilled and strung up on aircraft wire, with splices of barbed wire, to form the ribs.  The torso is made out of a six-gallon gas tank.  Brass tank shells form the legs.  The tank shells couldn't be welded directly; instead, they were drilled, fitted with angle brackets, and welded to the mortar "feet" and ammo box "hip" at the base of the sculpture.  The M-16 magazines were cut in half, length-wise, and drilled so that wire could be woven through them to stitch them in place as the shoulder and collarbones."  "As you can see, the arms are grenades," he says, "Two dozen grenades that have been quartered and welded back together (so that they're fragmented, but also to reassure the public that there's no longer any powder inside.).  The fractured head is made from a brass drum cymbal, which is shattered into at least 80 puzzle-sized pieces to resemble both shrapnel and skull fractures (typical combat injuries), each drilled with several holes so that they could be woven together with wire to form a type of chain mail.  There are also more grenade pieces, mini bomblets, and the tailfin of a rocket."  A side view of the sculpture, he says, "shows you where it gets its name: the fractured skull represents brain injuries."  The legs bear many of the previous names for PTSD, "particularly in wars before it was diagnosed as a mental illness.  Vietnam was really the first war that gave it a name and a treatment."

Hornbeck hopes that the sculpture succeeds in capturing what many soldiers experience when they return from war: PTSD, survivors' guilt, flashbacks.  He says he was compelled to build it on receiving news of three comrades who'd returned from war and taken their own lives.  Hornbeck wanted the sculpture to deal with "issues directly affecting our vets: like lowering their suicide rates and trying to re-integrate them into society when they return."  Says Hornbheck, "these aren't new issues, they aren't propaganda -- these are issues that have been deal with in every way, though somehow people forget them after those wars are past, only to rediscover them again with the next war.  This makes for a very poor learning curve for both society and the VA to have to deal with these same issues over and over again," separated by intervals with little continuity.

The "shattered" nature of the soldier portrayed, Hornbeck says, attempts to address the many injuries of war, seen and unseen: "PTSD, soldiers' suicides, TBI (traumatic brain injury), eye injuries, among others."  "Veterans returning with these injuries," he says, "tend to get overlooked, or until elections are over, empty promises are made to veterans to take care of their healthcare.  I made this to raise awareness of current veterans issues: I believe that mental health among our troops is largely getting neglected, as we hear of soldiers being redeployed into combat despite being diagnosed with PTSD, and being at risk to themselves and others." "So much for the screening process," he says.  "There comes a time when you look at the military institution itself and the culture of masculinity it creates and reinforces, that doesn't enable guys to really approach treatment willingly, without criticism from their peers."

Hornbeck says, "This sculpture was created as a memorial for the living; and for those who died over there or returned as ghosts of the war, forever haunted with guilt and remorse from being witness to unspeakable things, and sometimes committing some themselves."  He says his father struggled with PTSD, as he himself does.  He says, "My father suffered PTSD from his time in Vietnam.  Growing up, I witnessed his episodes and even went to the VA with him on several occasions, trying to get him help.  I've known three soldiers who didn't receive the treatment they should have, after returning, and committed suicide."  Hornbeck is aware that not everyone wells over with warm, fuzzy feelings upon seeing his sculpture, but many also say how it has touched them like no other sculpture they've seen.  "This sculpture deals with intense veterans issues that sometimes make people cringe with discomfort, but it's the only way I've seen to highlight such difficult topics that are otherwise hard to discuss."  "I created this sculpture out of elements of war," he says, "to show how the soldier becomes the war, even when they return."  "It isn't something easily forgotten," he says.

Editor's note: See previous posts here and here on this artwork to learn more; go visit the show in Providence, RI at the Pawtucket Armory, linked here; or go to John Paul Hornbeck's website to make a donation to the starving college student's art fund, for building and shipping this piece on exhibit.  Ideally someday this sculpture can find a prominent "resting place" in an important American collection, for its singular ability to capture some of the trauma of war for the soldiers who serve in it.

Shattered Soldier - Veteran Makes PTSD Art

Shattered Soldier is the creation of Vietnamese-American artist and Iowa college student, John Paul Hornbeck, himself a veteran and a PTSD sufferer.  It's making its way cross-country right now to an exhibit in Providence, Rhode Island in the beginning of March, at the Pawtucket Armory. The show called, "Experiencing the War in Iraq," will run from March 5 to 30th, and it is described as "an artist-curated multi-media exhibition that brings together diverse expressions of the war in Iraq."  Click here to learn more about the exhibit.

Says Hornbeck, "I made this sculpture to address the issues coming back from the Iraq War: increased rates of PTSD, mental illness, soldiers'/veterans' suicides, TBI (Traumatic Brain Injury,) blindness, among other things. This sculpture was created as a memorial for the living, for those who died over there or who returned as ghosts of the war -- forever haunted with guilt and remorse for witness to unspeakable things, and committing some themselves. My father had suffered PTSD from his time in the Vietnam War. Growing up, I witnessed his episodes and even went to the VA with him on several accounts trying to get him help. I've known three soldiers who didn't receive the treatment they should've and committed suicide. This sculpture deals with these intense veterans' issues that sometimes make people cringe with discomfort, but it is the only way I see fit to express such difficult topics that are otherwise hard to discuss.  I created this sculpture out of elements of war, to show how the soldier becomes the war -- and how, even when he returns, war is something not easily forgotten.

To see more images of "Shattered Soldier," or If you are able to donate to Mr. Hornbeck to help defray his considerable expenses in building and shipping this sculpture for exhibition, please follow this link to his website.  Thank you.

Combat Trauma & the Arts

Don't you hate learning about things after the fact that you really wish you could have gone to, if only you'd known?  Today's contender for that is an original play performed in 2006 at the Trinity Repertory Theatre in Providence, Rhode Island. The play is called "Boots on the Ground," and it's a 90 minute docudrama, "built around the words of nearly 70 soldiers and their families, medical workers, journalists, ministers, ethicists and teachers, who shared stories of courage, sacrifice and dedication, in Iraq and here at home."  The play was written and conceived by Laura Kepley and D. Salem Smith, the Rep's artistic associate-resident director, and playwright in residence, respectively.  All reports are that it was extremely moving and powerful, especially because based on actual personal experiences, artfully elicited and woven through the story.  Sure wish I could have seen it when it played.  If I learn more about its availability in any recorded form, I will post that information here.

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. 

The VA's PTSD Payments Vary Based on Where You Live - And They Shouldn't

Military.com has a very good article in yesterday's paper, called "PTSD Payments Vary from State to State."  Please take the time to read it.  It's one of those few articles where every word in it is worth knowing, and relevant to our topic.  The McClatchy Newspapers chain did some extensive independent research here.  According to the article, they took a look at "3 million disability compensation-claims records obtained under the Freedom of Information Act, as well as separate documents that the VA provided. The analysis is the first to examine the issue of state-to-state variations in compensation for those young veterans who have left the military since the war in Afghanistan began in 2001."

Okay -- and what did they find? They found that payments for PTSD disability vary widely from state to state, with no obvious reason why -- nothing deeper or more significant than how disability from PTSD is likely rated by your local VA.  So it turns out if you live in New Mexico, you're like to do better than say if you live in Montana.  There's a certain amount of complexity to this system that is worth learning.  A higher disability rating means a higher payment, but whatever you start getting paid at is what you get locked in being paid at, over time, so it's crucial to start with higher numbers, essentially, if you're young and are likely going to be relying on this check for life.  And the payments are not that high to start with.  The top of the scale, total disability, runs around $2500 a month -- and that's now -- not potentially 50 years from now, when you might still be relying on that payment.  Why VA benefits don't adjust for cost of living or inflation over time is beyond me -- seems like another thing veteran rights organizations need to take up with Congress -- congressional salaries certainly have that perk.  But nevertheless, where you start on the scale ends up being vitally important over time, and some states seemed skewed to give better results than others.  Again -- read the article, it's full of good information, and it'd be bad practice to quote the whole thing just to get that point across.  But here's some other good information from it:

The VA workers who decide PTSD cases determine whether a veteran's ability to function at work is limited a little, a lot or somewhere in between. They examine the frequency of panic attacks and the level of memory loss. The process is subjective, and veterans are placed on a scale that gives them scores - or "ratings" - of zero, 10, 30, 50, 70 or 100.

McClatchy's analysis found that some regional offices are far more likely to give veterans scores of 50 or 70 while others are far more likely to stick with scores of 10 or 30.

Consider the New Mexico and Montana offices, where there are big differences up and down the scale.

In Montana, more than three-quarters of veterans have ratings of zero, 10 or 30. In New Mexico, a majority of the veterans have ratings of 50 or 70.

On top of that, 6 percent of New Mexico veterans had the highest rating possible - 100, worth $2,527 a month - compared with just 1 percent of Montana veterans.

Because payments are loaded toward the highest end of the scale - the difference between the highest rating and the next-highest rating is more than $1,000 a month - the gap in ratings has a significant impact on how much the VA is paying, on average, to veterans in different states.

Factoring in all mental and physical disabilities, the average payment for recent veterans ranges from a high of $734 a month in the Little Rock, Ark., office to a low of $435 a month in Honolulu. In Roanoke, the average was $538.

And while we're on the subject -- the average payment is $435 a month to $734 a month?  Is anyone able to actually live on this money?

Editor's Note: Congratulations to the McClatchy Newspapers for doing independent research on this subject.  It's another case to me of journalism serving to move society forward.  In future years, getting the VA system of disparate compensation cleaned up will owe much to articles based on research like this, that showed there was a problem in the first place.  Thank you...

USA Today Blogs from "An Emotional" Congressional Hearing on Veterans Suicides

The Congressional hearings on suicide prevention among veterans are going on right now in Washington, DC.  USA Today is blogging about what they're calling "an emotional hearing."  Oh, yeah.  Consider the topic!  And the effect that it has on veterans and their families, not to mention, caregivers.  Here's the link.  The coverage is short and to the point, and very, very current.

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.

Military Psychologist Faces Own Combat Trauma

The military publication, the Voice of America, has an article today called, "Combat Psychologist Treats Trauma, and Deals with Her Own," about Heidi Squier Kraft, who served as a Navy psychologist at the combat hospital in Al-Asad, Iraq, and has recently published a book about her experiences called, Rule Number Two: Lessons I Learned in a Combat Hospital.  Here's what the basic information about the book is:

Book Description
When Lieutenant Commander Heidi Kraft's twin son and daughter were fifteen months old, she was deployed to Iraq.A clinical psychologist in the US Navy, Kraft's job was to uncover the wounds of war that a surgeon would never see.She put away thoughts of her children back home, acclimated to the sound of incoming rockets, and learned how to listen to the most traumatic stories a war zone has to offer.One of the toughest lessons of her deployment was perfectly articulated by the TV show M*A*S*H: "There are two rules of war. Rule number one is that young men die. Rule number two is that doctors can't change rule number one." Some Marines, Kraft realized, and even some of their doctors, would be damaged by war in ways she could not repair. And sometimes, people were repaired in ways she never expected. RULE NUMBER TWO is a powerful firsthand account of providing comfort admidst the chaos of war, and of what it takes to endure.

About the Author
Heidi Squier Kraft spent nine years as a psychologist for the US Navy before leaving active duty in March 2005. She lives in San Diego with her husband and children.

Click here for a link to the article in the Voice of America.  The article is a little surfacey, but still worth reading, about the special considerations of a trauma care provider who's also exposed to the same trauma in combat.  If you want to read more about women troop's experiences in the Iraq war, try also Band of Sisters: American Women at War in Iraq, by Kirsten Holmstedt.  And if you want to read a book about a combat doctor's time in Iraq, read the aptly-titled, On Call in Hell: A Doctor's Iraq War Story, by Cdr. Richard Jadick, or A Doctor Looks at War: My Year in Iraq, by Michael C. Hodges.  Those books aren't necessarily going to focus much on combat trauma, but at least they're tangentially on the topic.  And if you just plain miss M*A*S*H, there are a couple of cool items on YouTube: a tribute to the show, with a great choral version of the theme song, Suicide is Painless, playing in the background; and a straight-up acoustic guitar version of the song which is also wonderful, below: 

The Sacred Brotherhood of Veterans

This is a post I've been meaning to write for a while - because the incident that spurs it, while still a few weeks old, didn't get nearly the coverage that it could have, so it's still going to count as "news."

It seems clear that if returning combat veterans end up getting better treatment (and hmmmn, we're still waiting for that) these days, from the VA and from society at large, it will in large part be because of what earlier veterans -- in particular, Vietnam veterans -- experienced.  The Vietnam vets' unfortunately "bad" experience will somehow work to create a noticeably "better" experience for current combat veterans.  At least, that's the hope.  And not just ours, but many Vietnam veterans as well, who frankly have suffered enough, and if there's any benefit to their suffering whatsoever, want to see that it means the next generation might suffer a little bit less, in trying to uncoil themselves from combat and readjust to civilian life.  When I think of this phenomenon, I really do picture a bridge, or chain of arms -- from one part of the sacred brotherhood of combat vets to another -- reaching out, to make sure that they make their way across what can be very troubled waters.  Of course now the "sacred brotherhood" also includes women veterans as well, but rather than get lost in some murky, cumbersome language, let's just call it the brotherhood and realize it includes women vets as well.  Whoever's been through combat, innately understands what it took to live that experience, and instinctively can help others going through that, and ideally help them come to terms with their loss.

The point of bringing this up -- the focal point of this post -- is to introduce one great example of a  Vietnam veteran who, despite his rank, really didn't "forget" what it was like to go through combat, no matter how many years ago.  When General Peter Pace stepped down in early October as the Chairman of the Joint Chiefs of Staff, he apparently went straight from his good-bye ceremony to the Vietnam Wall.  And at the Vietnam Wall, to the shock and surprise of many onlookers, who came across these tokens over the next few weeks, he left three index cards, laid against the wall.  With his four stars rank pinned to each of them, and a handwritten note to each of the three buddies he'd lost, in the Vietnam War.  The notes each said something like, "These are yours, not mine! With love and respect, your platoon leader, Peter Pace"

Here's a couple of photos of General Pace's mementos, close-up and in place; and a link to a video at CNN, describing what happened.  Props to blogger Old Sarge for pointing this out, and giving us permission to republish the photos.  For a link to the Wikipedia entry on General Peter Pace, click here.

Empty Gestures: Is Veterans Day a Lip-Service Holiday Already, Even Though We're at War?

I'm just curious, because, for a Federal holiday, if I had to guess, I'd say that the majority of people actually celebrating -- meaning, giving honor to, paying respects to -- Veterans' Day were veterans themselves, veterans' families, and a very few interested others.  Everyone I talked to yesterday was at work - no holiday at all - and when I went to the supermarket later in the day, was surprised to see the Wells Fargo branch at the supermarket was open, with a long line of customers.  "We're open on Veterans' Day!" their printed sign proclaimed enthusiastically, as though we'd all really be cheered to know that honor was being ignored in favor of convenience and commerce. I, for one, wasn't that happy to see that.  To me, it just underscored the point that too few Americans are affected by this war, who don't personally have some skin in the game.  And that's not good, or right, AND it doesn't auger well for the future of veterans issues.  Issues that affect veterans directly affect all of us, as a society, and most of all, show our ability and capacity to care.  If what Paul Reickhoff says in this interview with MTV is true, and fewer than 1% of Americans are "suiting up" for this particular "game" -- the wars we're involved in, in Iraq and Afghanistan -- it's even more evidence of how veterans and their issues are getting marginalized.  Not good.  Veterans' Day -- and veterans issues -- aren't meant to be some insular, "you had to be there to get it" type of thing, affecting only the few, the proud, the actual deployed military  They'll always mean more, or mean differently, to those who served, but they are fundamentally, and foundationally, important to us all. Or ought to be.

[What did I personally do/the results of the Hyprocrisy Check(TM): I took time out to thank the veterans I personally knew; and the vet supporters, because their work counts as well; I wrote some more on the topic; read some articles about veterans issues, joined a live chat with a reporter who'd recently covered veterans issues about his coverage of same; and talked with a friend whose husband is getting ready to deploy again; then finished out the night watching some videos from his time in Iraq.  Not much, maybe, but way more than lip service.  If it's graded pass-fail, I'll give that a pass :-)]

British Soldiers Journey Back to Confront Ghosts from Combat Past

Because a percentage of our readership comes from abroad, and because the topic we cover is relevant internationally, today we note that the British press reported yesterday in two different articles how veteran combatants from the Falklands conflict are journeying back to confront the ghosts of their combat experience.  The Scotsman (Scotland) and the Guardian (England) both have articles on the subject, with much shared content between the two. 

The award-winning Guardian, consistently a great source of news and perspective, notes that "Two hundred and fifty Falklands war veterans - many still suffering psychological trauma from the conflict - will return to the islands this week. Their arrival and tour around local battlefields is timed to coincide with the 25th annual Remembrance Day Service [the British version of our Veteran's Day] since the 1982 Argentinian invasion." Furthermore, "among the former servicemen and women flying out are a group diagnosed with post-traumatic stress disorder (PTSD) who are hoping to exorcise the ghosts of the past."

The excellent Guardian also has new video they've created to honor the 25th anniversary of the war -- "watch the soldiers who were there relive their experiences and follow the war as it unfolded" -- and, if you're a history buff or just blank on what the Falklands War was all about, there's WIkipedia and this interactive guide on the Guardian's own site to clear up the confusion.

The Scotsman adds detail as well:

"SEVENTY former servicemen still battling with the psychological trauma of fighting in the Falklands War will fly to the islands today to face the ghosts of 25 years ago. The men, suffering post-traumatic stress disorder (PTSD), are among a group of 250 veterans from the 1982 conflict taking part in an anniversary pilgrimage to the battlefields in the South Atlantic.

For most of the men on the heavily over-subscribed [meaning, far more people signed up than were actually able to go] visit it will be their first time back since the British victory over Argentina.  The islanders - the population is less than 3,000 - are throwing open the doors to accommodate the party, including 15 relatives of those who died in the conflict, in their homes.  Organizers of the visit said that many local people have taken a week off work and offered their services as drivers for the party. One has even put a plane at their disposal to take them to outlying islands where they fought.

The event is being organized jointly by the main Falklands veterans body the South Atlantic Medal Association, and Combat Stress, the charity that works with ex-servicemen and women who are suffering psychological disabilities.  Combat Stress is providing around ten trained clinical support staff.

As well as those suffering PTSD many making the visit suffered major physical injuries such as losing limbs. Colonel Mike Bowles (retired), the chairman of the organizers, said: "Some of these guys did go through horrific experiences and saw horrific things. "I think going back and being able to be in a place and think about it and sit and maybe have some people around you, does help people come to terms with it."

But Col Bowles said the trip was also about seeing how the islands that they fought to liberate are thriving in 2007, and meeting the islanders themselves.  A total of 255 British servicemen and more than 600 Argentineans were killed in the war which ended the 74-day occupation of the islands.

Editor's Notes: (Highly miscellaneous.)  We've written about Combat Stress before.  See hyperlink.  It's the British variant on our term, combat trauma.  It's also the name of a service organization for combat veterans who suffer from PTSD in England. 

On a more serious note, notice how this event is happening 25 years after the conflict.  There seems to be a gigantic, painful lag in experiencing symptoms and confronting the past -- perhaps because of how painful it is, or how deeply the memories are buried.  This is consistent with our Vietnam veterans making trips back to Vietnam in recent years to confront the ghosts of their pasts there, and with decorated war heroes from that conflict, such as Max Cleland, who for many years headed the VA, taking 20+ years to realize that he was suffering from combat trauma himself.  In other words, it's likely to be a long, hard wait for veterans from Iraq and Afghanistan to be able to confront these experiences themselves, though we hope through many related efforts the cycle time is much shorter, for their sake. 

As Maxine Hong Kingston told me when I asked her how quickly vets were interested in writing (even for themselves) about what they'd gone through, she said that in her experience it had taken 20 years to come forward.  Perhaps that time from now on can be shorter -- but I think it underscores the gravity of the experience, and what these veterans have suffered, that it generally speaking takes that long.  Ouch.  Let's have as a goal, trying to close that particular loop, gracefully and graciously, with current veterans in a whole lot less time.

Harvard Study Says Almost Two Million Vets Lack Health Insurance

Ye Olde Alma Mater, Harvard University, published the results of a study earlier this week, showing that one in eight uninsured Americans is a veteran, and the numbers of uninsured veterans have continued to rise sharply since 2000.  Not good news for those who need continuous (meaning, uninterrupted) healthcare to resolve longstanding, chronic conditions like PTSD and the results of combat trauma.  Click here to read the story.  There are some pretty shocking statistics in there to absorb.  Says one doctor quoted in the article, "Only the government can put men and woman into military service and only the government can guarantee that they are covered after they serve." 

The study was conducted by researchers from Harvard Medical School, and published in the December, 2007 issue of the American Journal of Public Health.

No One Who Goes, Comes Back Unchanged

In the category called, "Something Good We've Been Missing," here's a story we entirely missed, in an online publication called "GOOD," which profiles a number of veterans and their experience in wartime. Again, apolitical coverage -- just a little consciousness-raising that the vast majority in this country is sorely in need of, about what it really means to go to war.  It's a photo series, with commentary, introducing us to a number of "typical men and women" who served in combat.  Their stories, and the photos that accompany them, are compelling.  Do yourself the favor of acquainting yourselves with these cool Americans.  The pull quote alone that introduces the article,tells the story: "One-and-a-half million Americans have served in Iraq and Afghanistan. Not one of them came home unchanged."  In the introduction to the article, Paul Rieckhoff, Executive Director of the Iraq and Afghanistan Veterans of America, writes:

The statistics are shocking: more than 11,000 soldiers have been wounded by roadside bombs; more than 50,000 have sought treatment for post-traumatic stress disorder; and 150,000 have submitted a claim for disability. Undiagnosed brain injuries—serious concussions that can cause memory loss, vision problems, and even depression—are affecting as many as 300,000 troops who have come home.

But when you look at the numbers, it’s easy to forget that they represent individual stories: lives put on hold, families under strain—above all, tremendous personal sacrifice.

He also says, compellingly,

I’ve found that the faces of the troops tell us the most about the war. Their eyes reflect their pride in their service, pain at the loss of friends, and the memories that linger long after they return home. In a way the numbers simply can’t, the faces of combat veterans bring the reality of a distant war home. That’s why images like these are so important; they remind us that “the troops” aren’t some abstraction to be supported by a bumper sticker or a catchphrase. The troops are America’s sons and daughters, a diverse group, coming from all parts of the country and every walk of life.

This is great writing, with heartfelt concern behind it, as impetus.  There's kind of a harsh joke circulating lately, with its origins in a photo on a wall in Ramadi, Iraq, that says, in paraphrase, "America isn't at war -- the Marine Corps is at war.  America is at the MALL."

As we get ready for Veteran's Day in America on November 11th, it's not a bad idea to prepare for it in our own hearts, by actually giving a damn about those who served, not only in these wars but in previous ones as well, and what their quality of life is like now.  "Support our troops" can and should become more than just convenient lip service.  It could become heartfelt concern and caring, and best of all, for the veterans' sake -- actual constructive action on their behalf.

Reporters Help Move a Nation to Care, Too

If you were in Harvard Square tonight, you could have gone to hear Dana L. Priest, one half of the outstanding duo of Washington Post reporters, who, along with Anne Hull, have been contributing so many excellent stories on the health care and combat veterans at Walter Reed and beyond.  Until I read the blurb from Harvard's Institute of Politics ("IOP"), part of the John F. Kennedy School of Government, where Priest is speaking, I didn't realize that she had won a Pulitzer Prize last year for her reportage.  Belated congratulations for some truly excellent work.  Here's Priest's bio, according to the IOP:

Dana Priest, the 2006 Pulitzer Prize winner for beat reporting, covers the intelligence community for The Washington Post. She spent the previous eight years writing about the U.S. military. Her book, "The Mission: Waging War and Keeping Peace With America's Military," was published in Feb. 2003. She has worked at the Post for 15 years, where she was the Post's Pentagon correspondent for six years and then wrote exclusively about the military as an investigative reporter.

(Sources: NY Times, PBS, the Washington Post)

And here's a list of articles she's written recently, from the Washington Post.  Also a list of Anne Hull's  articles, which frequently intersect.  Because reporters don't often get treated like rock stars, no matter how many Pulitzers they get, it's cool that Priest is going to be at the IOP.  Her reportage is actually moving society forward on the topic of veterans right to health care.  More power to her, and her reporting team, for the great work they've been doing, sensitizing us to things we wouldn't ordinarily get to see, unless we were intimately involved.  That's part of the power of great reporting.  In the immortal words of the title to Ilona Meagher's book on the subject, it's part of "Moving a Nation to Care."

(Military readers and others often pooh-pooh or villify the "mainstream media" for missing all the good stories, in favor of preferring to read bloggers, who often have no journalism background whatsoever.  However, in defense of the mainstream media -- or at least good journalists like Priest and Hull -- check out what happened AFTER their recent article was published in the Washington Post, one we blogged about here.  The subject of the article, Troy Turner, suddenly went to the head of the line, in a pretty impressive fashion:

In addition to granting Turner a coveted spot in a residential treatment program at the Martinsburg VA Medical Center, the department is increasing his disability rating from 70 percent to 100 percent, according to a VA spokeswoman, raising his monthly check from $1,352 to $2,781. The new rating also means that Turner's wife, Michelle, and their two children are eligible for medical insurance and educational benefits.

Why did this happen?  NOT because Turner was strangely more deserving than other vets, not because the VA had been sitting around with nothing to do and the Post story galvanized them into action, but because the media spotlight made the situation uncomfortable, touched hearts, and spurred action and change.  Would that every returning veteran have the same opportunity.  We really do have reporters like Priest and Hull to thank for that.  Soapbox over.  Read the new article, though, it's great.)

Into the (Mental Health) Gap - Military Chaplains and Others

I was hunting around on the Web tonight for material for a different post entirely -- one about the rumor that military chaplains are being pressed into service as stop-gap mental health counselors -- and whether this is a good, albeit temporary solution -- or an overly simplistic band-aid with unforeseen complications -- when I came across this news item instead.  It's a pretty good wrap-up, from a good reporter at the Air Force Times, Karen Jowers, about some solutions the military, particularly the Air Force, is offering its servicemembers to cope with combat trauma, PTSD, and long deployments.  The article is worth reading, and is linked here.

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As far as the chaplain topic goes, which I wasn't able to find enough information about to verify that it is indeed contemplated, here are some off the cuff thoughts.  One is, and probably paramount, anything is better than nothing, if it goes to the good of the afflicted servicemember.  If there's too long a wait at the VA to see somebody, provided that the chaplain is generally qualified and perhaps even recently trained in PTSD and related issues, far better to see someone, quickly, than no one, or to have an unduly long wait.  It sounds like too many people can't endure the wait, when they've got troubling topics on their minds.

That said, let's hope that's not being proposed as anything other than a stop-gap solution, while the VA fixes the problem it has of too much demand and too little supply (qualified counselors, able to make appointments with veterans.)  I only know anecdotally of three different chaplains in the military lately, and the stories are mixed.  Story #1, referenced earlier in a blog entry here, is about a chaplain who himself suffered PTSD after being deployed to Iraq, then was sent to Hurricane Katrina while he was still affected, and though he was a middle-aged man with a wife and family, was so stressed out by the experience that he is now divorced and homeless.  That's not a good story, but it was told to me by the mother of an Army soldier who committed suicide after coming back from Iraq, and ironically, it was the chaplain who had been a source of support for him earlier; until the chaplain's own exposure caused troubles larger than what he could handle.  That's Story #1 that I know about, and it's negative.   

Story #2 is the cheery-seeming, snappy-sounding, highly quotable, funny and cool chaplain from the Minnesota National Guard, who's quoted in so many of the NPR stories from 2006.  (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.) He sounds generally delightful, sane and grounded -- and really an asset to those he's around.  That's Story #2, and it's uniformly positive. We don't know the man personally, of course, but he's made a great impression on us, and, it would seem, on NPR as well.

Story #3 I was exposed to the other night, when I was chasing down more information on the Web  about  the wonderful Maxine Hong Kingston and the book she edited, Veterans of War, Veterans of Peace.  I was able to see her and a panel of combat veterans and interested others, whose pieces make up that book, in Santa Rosa, CA recently, and wrote about it on this blog.  I've also watched the Bill Moyers special that aired over Memorial Day weekend last year about her book, which covered a few of the participants as well.  There are only two videos I've found on the Web that relate to Maxine Hong Kingston and her work with the veterans' writing project, and recently I watched both of them.  They're located here and here.  In the second one, one of the panelists at the talk at the Commonwealth Club in San Francisco, in April of this year, is a young Marine named Jim Castellanos, who tells a quite cautionary tale of turning into a conscientious objector as a Marine, and more particularly, for the purposes of this blog entry, about being what amounts to "blamed and shamed" by the chaplain he's required to see, which only serves to further burden the already conscience-stricken young man.  (If you want to watch the video, it's embedded below, and Castellanos starts telling his story at about the half hour point into the video -- minute 30 or so.)  (See Wikipedia, linked here, for a definition and background of what a conscientious objector is, a term familiar to many of us from the Vietnam War.)

Again, the focus of this blog is apolitical, so including this story isn't to be pro-war or anti-war or anything but pro-veteran.  However, his story is pretty troubling, in terms of the communication he had with the chaplain assigned to him.  It sounds like the chaplain was a South Vietnamese guy who had immigrated to the U.S., joined the military, and been deployed several times with the Marines.  Perhaps his OWN experience of living in war-torn Vietnam as a maturing adult contributes heavily to his own bias, but he appears to not be aware of this bias when he is "counseling" Castellanos. 

The synopsis of the story is that Castellanos, who had joined the Marines at 17 in high school, later had a change of heart -- perhaps due to the maturing process, perhaps due to reading more philosophical texts in college, whatever -- and decides that he's really not cut out to be in the military after all -- doesn't want to carry a gun and doesn't want to kill people, for any reason -- in other words, pretty much the poster boy for a well-reasoned, Conscientious Objector -- the chaplain he meets with is someone it's hard to picture has ANY people skills or therapeutic counseling skills.  Castellanos tells the story from his own perspective, of course, but it sounds like the chaplain was pretty harsh with him -- and really taunted him, in a fairly unprofessional way -- about his ideology, to the point that Castellanos apparently felt worse off from meeting with him, than if he never had had the conversation. 

Later, he's able to meet a more reasonable person and talk to him about his feelings -- not that the Marines ever ultimately accept his plea to become a Conscientious Objector -- but to say that the first chaplain "got all up in his grill" is pretty descriptive.  Castellanos was already troubled about his decision, just based on internal pressures he was feeling, and the chaplain did nothing but mock him and essentially increase the external pressures.  Someone like this isn't someone you'd really like to see doling out any pastoral care to troops with sensitive issues and psychological pain.  Don't take my word for it, watch the video, and hear it from Castellanos himself.  So that's Story #3, and the chaplain was very destructive, and insensitive to the point of being actually harmful.  So out of three stories: that's one positive and two negative.  Granted it's a small sample but it's not filling me with confidence on the topic as a whole.  What I'd like to see, and what I'm sure a lot of us would like to see, is the VA just stepping up to deliver the care that's needed, with qualified counselors and speedy wait times for veterans.  Stop-gap measures probably shouldn't be anything but the most temporary solution.  That said, if it brings any veterans needed relief in the meantime, while the system is being fixed, more power to 'em.

Veterans Helping Other Veterans

Watch the public service announcement, PTSD is implied, from the National Veterans Foundation, featuring Dan Lauria.  Short and sweet, in the sense of being brief and to the point, constructive and helpful.  The NVF is staffed by veterans, for veterans, and has a toll-free number, available 24/7. That toll-free number is 1-888-777-4443.  The NVF calls itself "The Lifeline for America's Veterans".

                                                                     

"Must Have Been a Real Mean Bottle" - Veterans, PTSD and Substance Abuse

The relationship between trauma and substance abuse, or in our case, PSTD and self-medication through drugs and alcohol, is well-known. Some "sobering statistics" about substance abuse and veterans -- pun quite intentional -- follow here:

• Substance abuse rates are higher among veterans than their non-veterans counterparts.
• 76% of all homeless veterans suffer from drug, alcohol, or mental health problems (National Survey of Homeless Assistance Providers and Clients, 1999).
• According to an Army Post-Deployment Reassessment Study completed in July of 2005, alcohol misuse among soldiers rose from 13% among soldiers to 21% one year after returning from Afghanistan and Iraq.

(These statistics from the excellent fact sheet at the National Veterans Foundation - "The Lifeline for America's Veterans" -- called "Facts about Veterans: Needs and Solutions." Click here for the link to the fact sheet; click here for the link to the organization.)

There's even at least one scholarly book written on the subject, Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders, edited by Paige Ouimette, Ph.D., and Pamela J. Brown, Ph.D. Washington, D.C.: American Psychological Association (2003).  [Editor's note: "comorbid" means "appearing together."]

In a review of it by psychiatrist Edward J. Khantzian, M.D., of Haverhill, Massachusetts, he writes that his experience, "spanning four decades of clinical work involving patients with substance use disorders," has led him to conclude that "suffering is at the heart of addictions.  Nowhere is this more evident than with individuals who have developed posttraumatic stress disorder (PTSD) and resorted to addictive drugs to medicate the distress and pain associated with PTSD."

In future blog posts, we'll cover this topic in greater depth, but for the present, it's important to note how closely intertwined the two concepts are: if combat trauma or PTSD is a "normal reaction to abnormal events," it's no surprise that so many veterans of combat attempt to medicate the most troubling and painful experiences away through misuse or overuse of drugs and alcohol.

(The blog post's title comes from the country song, originally written by Vince Gill, and performed by Bob Seger and Kid Rock on Seger's latest album, Face the Promise.  To see a video of Seger and Rock singing this in concert recently on YouTube, click here.)

The toll free number for the National Veterans Foundation is 1-888-777-4443.

British Soldier Wins Award for Speaking Frankly about Combat Trauma / PTSD

There's a fantastic article in the British paper, the Guardian, today entitled, "You Can Teach a Man to Kill, but Not to See Dying," by Mark Gould.  (The Guardian, for those who don't know it, is a superb newspaper that frequently wins awards for its design and content, including the National Newspaper of the Year, given by the British press association.)  This article is about an ex-soldier who served in the Falklands War, winning a national mental health award for speaking "frankly and forcefully on the mental distress of war veterans."  You can listen to him talk about combat trauma (called "combat stress" in the UK) in the audio clip here, but be sure to come back and read the article as well -- it's wonderfully written and full of great, quotable quotes from the ex-soldier himself.

The award-winning ex-soldier, Chris Duggan, a Welshman, is remarkably forthright about his experience - what caused it, how far down he spiralled, and what eventually helped pull him back out.  At least in America we've given very little consideration to wars like the Falklands conflict, and even the more recent Gulf War, in which we participated, when it comes to combat trauma.  There's an overall sense that if the conflict didn't go on "that" long, how bad could the experience have been?  Perhaps especially when contrasted with wars that dragged on for years.  However, depending on what the combatants experienced, their pain and suffering is equally raw.  Duggan does a superb job of telling the truth about his own experience, and it's great to see the work won an award.  He also mentions, positively, the group "Combat Stress," which provides assistance to soldiers in the UK who've experienced combat trauma or PTSD.  We blogged about them earlier, in March of 2006.  Click here for that blog entry.

Duggan is refreshingly blunt and candid about his experiences, which is part of what makes it so worth listening to.  And he has some unforgettably graphic quotes -- deservedly so -- about combat trauma and its effects on the human mind and body.  Three cheers to Duggan and the British mental health awards for responding so positively to truth-telling from a veteran.