Healing Combat Trauma

Paying Tribute at "The Tribute Wall..."

One of the most remarkable experiences, at last week's third annual "The Brain at War" conference in San Francisco, was visiting the Marines' Memorial Club & Hotel in Union Square, where the conference was held.

Unbeknownst to me and many of the other conferences' participants, the Marines' Memorial is both swoon-worthily fantastic as a venue AND happens to house a one-of-a-kind tribute to OIF and OEF veterans who have been killed in action. The so-called "Tribute Wall" is on the 10th floor, mezzanine, and Major General J. Michael Myatt, USMC (Ret.) encouraged us all, during the conference, to take some time and pay honor to those servicemembers who had given the   ultimate sacrifice. 

True to my nonexistent personal GPS, I first mistakenly went to the wrong floor -- the library, on the 11th (which was cool, but not the same) -- and finally found my way to where I was supposed to be. The polished black plaques, listing fallen warriors by name, branch, and date of death, cover the four walls of the memorial room, and then stretch out beyond it, covering a "fifth" wall completely in the adjoining room, and continuing to advance.

If you know when a friend or loved one died in combat, you're able to find the plaque's general location by scanning the wall to find the correct year, then reading vertically to find the approximate location of the date.

If you know only a name, but not the date, it's safest to look up the name of the servicemember in the frequently-updated list kept in a binder in the center of the room, again listing by name, branch of service, and date of death.

In my case, I went to a section of the wall to find those who died on a certain tour of Marines in the Sunni Triangle, back in '05/'06, then went back to find the names of friends of friends and take photos for them of their loved ones' plaques.

There are some surprises. One is, see photo at left, that two "major league" departed heroes, among all the rest of the great departed heroes, Pat Tillman (Army) and Jason Dunham (Marines) died on the same day. Until I saw their plaques resting above each other on the "Tribute Wall," I can't say that I realized that. 

There's also a guest book which people can sign, to leave their memories and condolences; and there's a flag display of the flags of all the branches in the center of the room. There's also a framed photograph of Marine General James T. Conway, (at this writing, current Commandant of the Marine Corps) from the front cover of a Marine magazine, visiting the wall; and another framed "thank you" note he wrote, expressing his appreciation to the Gold Star families for the exhibit.

I found myself returning to this generation's "Wall" time and time again during the conference, sneaking away from the (great) presenters to put myself back in touch with the very great losses of these wars, in terms of men and women who were dearly and deeply loved by those they left behind. I racked my brain and texted friends for the names of friends they had lost on their tours, to make sure I got photos of their loved one's plaques.

In numerous trips to the Tribute Wall ("Room" is more like it, since the plaques cover at least five walls by now), I rarely saw another visitor. Only one couple, the wife or girlfriend tagging behind the husband or boyfriend, who looked like a veteran, searching out key names on the wall. I heard that a number of conference participants also went to pay their respects. I didn't run into them, which doesn't mean they weren't there. What the hushed and reverent silence in the room did mean, though, and the literally thousands of plaques, each representing a servicemember important and loved to many friends and family, is how little we typically recognize the ultimate sacrifice of those who   gave their lives. I feel blessed and honored and frankly, grateful, that I got to pay my respects at the Tribute Wall for those who gave so much.

If you're ever in San Francisco, and you can handle seeing the sheer enormity of OIF and OEF deaths honored in one single "room," you owe it to yourself -- nay, them -- to go by the Marines' Memorial Club & Hotel, head to the 10th floor, Mezzanine, and pay your respects, so that their sacrifice is not in vain.

Editor's note: Servicemembers who were KIA from all branches of the Armed Forces are represented on "the wall," not just Marines.

Wyoming Takes More Steps to "Guard" Mental Health

More good news from Wyoming.  NPR reports today in their show, All Things Considered, that Wyoming is "about to mobilize its largest deployment of National Guards in state history. Embedded with the troops will be a mental health professional who is a PTSD specialist. The commander of the Wyoming Guard believes treating the mental health needs of the National Guard troops is a priority and he has also worked to connect mental health resources in Wyoming communities to those in the military."

For a link to that story, entitled "Embedding Mental Health in the National Guard," and originally reported by Wyoming Public Radio, click here.

Reservists, Guard Personnel at Risk for Alcohol-Related Problems

Higher Risk of Alcohol-Related Problems for Reserve, National Guard Personnel

Younger service members and Reserve and National Guard combat personnel returning from the wars in Iraq and Afghanistan are at increased risk of new-onset heavy drinking, binge drinking, and other alcohol-related problems, according to a recent study in The Journal of the American Medical Association.

Isabel G. Jacobson, MPH, of the Naval Health Research Center in San Diego, and colleagues examined whether military deployment to the wars in Iraq and Afghanistan is associated with new-onset or changes in alcohol consumption, binge drinking behavior, and other alcohol-related problems. Data were derived from questionnaires completed by participants at the beginning of the and follow-up. After the researchers applied exclusion criteria, the analyses included 48,481 participants (active duty, n = 26,613; Reserve or National Guard, n = 21,868). Of these, 5,510 deployed with combat exposures, 5,661 deployed without combat exposures, and 37,310 did not deploy.

The researchers found that among Reserve or National Guard personnel who deployed with combat exposures the rate of new-onset heavy weekly drinking was 8.8%; the rate for new-onset binge drinking was 25.6%; and for new-onset alcohol-related problems, 7.1%. Among active-duty personnel, new-onset rates were 6.0%, 26.6%, and 4.8%, respectively. Among Reserve/Guard personnel, deployment with combat exposures was associated with increased odds of new onset of all three drinking outcomes compared with nondeployed personnel, with heavy weekly drinking (63%) and alcohol-related problems (63%) showing the strongest association.

Among active-duty personnel, those deployed with combat exposures were at increased odds (31%) of new-onset binge drinking at follow-up. Those born after 1980 were at 6.7 times increased odds of new-onset binge drinking and 4.7 times increased odds of new-onset alcohol-related problems. Those with PTSD and depression were at increased odds of new-onset and continued alcohol-related problems at follow-up.

“These results are the first to prospectively quantify changes in alcohol use in relation to recent combat deployments. Interventions should focus on at-risk groups, including Reserve/Guard personnel, younger individuals, and those with previous or existing mental health disorders,” the authors concluded.

— Source: American Medical Association 

Chaplain John Morris, Minnesota National Guard

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

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

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

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

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

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

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

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

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.)

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.

Vermonters Get Help for PTSD / Combat Trauma

The Boston Globe reports today a program to help returning veterans with combat injuries from TBI to PTSD has been expanded, thanks to a Federal grant.  Says the Globe:

A Department of Defense appropriations bill signed by President Bush contains $3 million for expanding the Vermont National Guard Outreach program and another $3 million for other states to reach out to troops returning home from Iraq and Afghanistan.

The program, which began about a year ago, also reaches out to soldiers back from Army Reserve units or active duty soldiers who have returned to civilian life.

Vermont U.S. representative, Bernie Sanders, quoted in the article, a political independent (like many Vermonters!), says, "This is a hugely important issue, because we are seeing a staggering number of people coming home with PTSD and traumatic brain injury," said Sanders, I-Vt. "It is terribly important that these people get the help they need and in order to do that, we need to do this effectively."

The Federal funding will go towards "boosting the number of outreach workers and establishing a toll-free 1-800 number for veterans to call," said Jim MacIntyre, coordinator of the Vermont National Guard Outreach team, quoted in the article, continuing, "It's a positive step...the need is growing every day."

It looks like matching funds are being made available for other states to do what Vermont is doing; but  props to Vermont for leading the way in securing Federal funding for this very necessary outreach.  (Click here for a link to the article.)  For more information about this program, especially as it affects Vermont, read this press release from Rep. Sander's office, online.  Click here for that link.

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.