Healing Combat Trauma

Shinseki for VA Head: A Good Choice?

The national news media since Sunday has been abuzz with the news of the appointment of General Eric K. Shinseki (RET) to head the Department of Veterans Affairs (the VA) in the Obama administration.  But despite the many positive things I've read about Shinseki and his appointment, I have yet to really get a clear impression of WHY he will be great for veterans.  He IS one; that's a good thing.  And he's a wounded veteran (another good thing).  And one who stood up to the powers that be and seems to have integrity, a good head for strategy, and a reluctance to showboat and hog the spotlight.  Great.  All good things.

But what I haven't read is anything compelling about Shinseki's concern for veterans and their families. Just who he is as a person and how he estimated troop strength better than others.  The Dept. of Veterans Affairs is so obviously the main conduit for delivering health care and benefits to veterans and their families, I'm a little nonplussed as to why he was the perfect choice for that, say, versus a Patty Murray (D-WA), a Tammy Duckworth (D-IL), or a Max Cleland (who headed the VA successfully in the Carter Administration and beyond).  All three (and probably others) were strong candidates: Was Shinseki that much stronger? He's very reserved (not necessarily a bad thing, but...it means we don't know much about what he really thinks about various issues relating to veterans and their care.)

Don't forget the Abraham Lincoln quote, enshrined as the motto of the VA, that says in part:

"let us strive on to finish the work we are in,
to bind up the nation’s wounds,
to care for him who shall have borne the battle
and for his widow, and his orphan..."

When I think about the VA, I wonder who in particular can stay on message with THAT mission.  Will Shinseki be able to?  Let's hope so. It's vitally important that someone does...

Again -- great if it turns out he does a great job, and really cares for veterans and their families, and their significant plight and peril.  But otherwise, why not someone who's already got a track record caring for veterans?  Sometimes it's hard to understand how and why these decisions get made.  Seems like we need Shinseki's leadership in the Pentagon more than in the VA.  But ideally he will turn out to be a great appointee, if we can further define what would make a great appointee.  Someone who makes sure that veterans get the care they need; that their families are included in the process; and that strides are made to both simplify the process and to reach out to deliver health care to veterans in outlying, rural areas.  Maybe Shinseki's strategic side will help here.  We certainly hope so.  Fingers tentatively crossed, but without the gushing that seems to be abounding these days re: this particular appointment...The need is just so great, and it's not going to go away, but rather, continue to grow.

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Editor's note: There's also this great quote, allegedly from another fave former president, George Washington, which Friend of Veterans Kathie Costos uses as her email signature:

"The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive veterans of early wars were treated and appreciated by our nation." -- George Washington. 

Just another reason why leading the VA is such an important charge...

VA is On the Move with Mobile Counseling Centers

VA to Deploy Mobile Counseling Centers Across America

The first of a fleet of 50 new mobile counseling centers for the VA Vet Center program was recently put into service with the remainder activated over the next three months.

"Our widespread distribution of this fleet from coast to coast marks a new chapter in VA's innovation to reach rural and underserved veterans with high-quality readjustment counseling," says VA secretary James B. Peake, MD.

Each vehicle will be assigned to one of VA's existing Vet Centers, enabling the center to improve access to counseling by bringing services closer to veterans. The 38-foot motor coaches, which have spaces for confidential counseling, will carry Vet Center counselors and outreach workers to events and activities to reach veterans in broad geographic areas, supplementing VA's 232 current Vet Centers, which are scheduled to increase to 271 facilities by the end of 2009.

Vet Centers, operated by VA's Readjustment Counseling Service, provide nonmedical readjustment counseling in easily accessible, consumer-oriented facilities, addressing the social and economic dimensions of post-war needs. This includes psychological counseling for traumatic military-related experiences and family counseling when needed for the veteran's readjustment.

The team leader at each Vet Center will develop an outreach plan for use of the vehicle within that region, not being limited to the traditional area of a particular Vet Center. These vehicles will be used to provide outreach and direct readjustment counseling at active-duty, reserve and National Guard activities, including post-deployment health reassessments for returning combat service members.

— Source: Department of Veterans Affairs

Military Sexual Trauma Increases Likelihood of Mental Health Problems, VA Says

From a press release, this fairly obvious conclusion:

Military Sexual Trauma Associated With Higher Rates of Mental Health Problems.

According to preliminary research results from the VA, approximately 15% of recently returned female veterans utilizing the VA healthcare system report experiencing sexual trauma during military service.

The cross-sectional study, presented at the American Public Health Association’s 136th Annual Meeting & Exposition in San Diego, examined healthcare screening data of over 100,000 veterans of Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom who utilized medical care at any Veterans Health Administration facility during a six-year period.

Along with the more than one in seven women, 0.7% of males also reported having experienced military sexual trauma. Both males and females reporting military sexual trauma were more likely to be diagnosed with a mental health condition than patients who did not report military sexual trauma.

“These data highlight the importance of the VA’s universal screening policy,” said Joanne Pavao, MPH, a VA researcher on the study, “as well as early intervention among veterans who have experienced sexual trauma, to prevent long-term consequences.” Veterans Health Administration policy requires that all male and female veterans are screened for experiences of military sexual trauma and that free treatment for military sexual trauma-related conditions is provided at all VA healthcare facilities.

— Source: American Public Health Association

In the News: Two Articles Worth Reading Recently

Two articles worth reading that have been in the news recently:

"How the VA Abandons Our Vets," by Joshua Kors, in The Nation, linked here; and the poorly-headlined but otherwise worthwhile"Military Town Newspaper Challenges U.S. Military on Murder of Military Women," by Ann Wright, in TruthOut.org on the Web, linked here. 

Kors' article talks about the recent veterans' class-action lawsuit against the VA, fought in Federal court, and WHY it was necessary -- and there are some interesting and unexpected points, which didn't show up elsewhere in enough detail.  The biggest one is about the "fuzzy math" the VA employs to calculate claim times, and how this uniformly works against veterans (no pun intended on the "uniformly" thing.) It also confirms a longheld impression on my part that a veteran who struggles intensely with the mammoth difficulty of being his or her own advocate in the process, and ends up committing suicide, is actually counted as a "victory" for the VA, who calls their claim "resolved" in the time it took them to kill themselves.  In other words, fellow veterans killing themselves while waiting for their claims to be resolved actually makes the VA look "better and faster" at resolving claims, if you can believe that.  Yikes.  Talk about a system that needs to be overhauled and addressed...

Another great point Kors makes is that "someone" already attempted -- but was fired for her efforts.  That "someone" is Frances Murphy, M.D., who in 2004, according to Kors, "helped draft the Mental Health Strategic Plan, a blueprint for overhauling the VA.  The plan called for 256 changes to the organization, among them: installing a tracking system to stay in touch with suicidal veterans, creating rehabilitation programs that involved veterans' families, and streamlining the benefits process to resolve wounded veterans' immediate needs."  However, after expressing her frustration in public (to mental health providers) about the barriers the VA erects to veterans' speedy care, and how this causes veterans to suffer additionally and unnecessarily -- she was summarily fired.

Read the Kors piece to understand what wounded veterans have to go through, and how unfair it is; and to get a better picture on the fuzzy math that's employed to make things seem much better than they are.

The Ann Wright piece talks about military wives and women servicemembers murdered recently by other servicemembers, and mainly serves to remind us of how this is a problem that isn't going away.  The "news peg" for her article is a recent editorial in the Fayetteville, NC Observer -- Fayetteville is close to huge Army and Marine bases -- called "Our View: Military Domestic Violence Needs More Aggressive Prevention" (speaking of odd word choices).  That editorial is linked here.  The editorial references a recent vigil to memorialize the murdered women locally.

In conjunction with the Helen Benedict material and the other writings on Military Sexual Trauma, blogged about recently, here -- this is a topic worth keeping in the forefront of our minds.  Collateral damage from combat trauma? Or just crimes committed by otherwise sick individuals who happen to be in the military?  Either way, "more" needs to be done about this terrible problem.  (A similar and related topic is the "non-combat deaths" one we discuss from time to time, which can sadly be what's used to describe what more actually is a victim's suicide or a "domestic violence" type murder, of one servicemember by another.) We're just about to add a series of blog posts about domestic violence, and why it's important to leave when you're at risk, but ideally how to do so in a way that preserves your life.  Look for that shortly.

About the authors:

Joshua Kors is an investigative reporter for The Nation, where he covers military and veterans' issues. He is the winner of the National Magazine Award, George Polk Award, IRE Award, National Headliner Award, Casey Medal, Mental Health Media Award, and the Military Reporters and Editors Award.  He was also a finalist for the Michael Kelly Award, Tom Renner Award, Harvard's Goldsmith Prize for Investigative Reporting, and the American Bar Association's Silver Gavel Award.

Ann Wright is a retired US Army Reserves colonel with 29 years of military service. She also was a US diplomat who served in Nicaragua, Grenada, Somalia, Uzbekistan, Kyrgyzstan, Sierra Leone, Micronesia and Mongolia. She is the co-author of "Dissent: Voices of Conscience," profiles of government insiders who have spoken and acted on their concerns of their governments' policies.

Learning to Bounce Back: Helpful Hints for Increasing Personal Resilience

"Resilience" or the concept of "increasing personal resilience" is something we're hearing about more and more in connection with PTSD.  For combat veterans and their families, the greater the amount of personal resilience, the more fully they'll be able to "bounce back" from trauma (hence the image of the boomerang, which quickly returns to its source.)

 

According to the dictionary, "resilience" is "The ability to recover quickly from illness, change, or misfortune; buoyancy;" and the intrinisic "property of a material that enables it to resume its original shape or position after being bent, stretched, or compressed; elasticity."

According to the National Center for PTSD, and its PowerPoint presentation on PTSD 101, presented by Fred Gusman, M.S.W. and colleagues, three keys to resilience are the "ABC's" of "awareness" (of one's limits, emotions and resources); "balance") among personal and professional activities [their presentation was to clinical caregivers, so that's explains the inclusion of that sentence]; and "connection" (to one's inner self; to others, and to something "larger" (typically spiritual).) A connection with others, in particular, "breaks the silence of unacknowledged pain; offsets isolation; and increases validation and hope."

 

The short, pithy presentation also offers these

 

Helpful Hints for Personal Resilience:

• Make connections/relationships;
• Avoid seeing crises as insurmountable problems;
• Accept that change is inevitable;
• Set goals and actively move toward them;
• Take decisive actions;
• Look at problems as triggers for personal growth;
• Don’t blow things out of proportion;
• Remember and use past coping, success, strengths. 

-- Source: APA Task Force on Resilience, 2002, quoted in National Center for PTSD’s "PTSD 101," linked here.

Eyewitness to Combat - Misplaced Guilt Trip - Even the Survivors Lost (Survivor's Guilt)

This is possibly the most intense and heart-wrenching of the reminiscences of Pat, the young Marine who served two tours in Vietnam, whose recollections we are excerpting in this "Eyewitness to Combat" series.

 

He is shot five times, in the arm, leg, back and head, seriously wounded, medivaced out of Vietnam, and recovering stateside in Balboa Naval Hospital, when he gets some news that will change his life forever. If you read the foregoing episodes in the series, you learn a little of what the combat he saw was like. 

 

But let's pick up in his own words with how that affected him:

 

"Almost everything that I had done and experienced generated a corrosive guilt that continued to diminish any hope of a joyful life that I could have had. But the one event which brought overwhelming guilt and probably attributed more to my “death wish” than anything else was the one event which I had not even taken part in.

My unit had been completely destroyed and I wasn’t there to die with them. I was a coward: I had run away and hid and because of this, I was responsible for the complete elimination of “Bravo” Company.

 

That is what my mind was telling me -- even though I was stationed in the Balboa Naval Hospital, being treated for severe wounds that I had received when my platoon had been ambushed and annihilated on Hill 861 S. in Khe Sanh, South Vietnam.

 

I was notified of this event when a Navy Corpsman came into the ward that I was confined to and said “Weren’t you in Bravo Company, 1/9? I found an article in Time magazine that has an article about them getting wiped out. I thought you would like to read it.”

 

He could not have affected me more if he had hit me in the stomach. I read it and I silently cried for the first time since I had returned.

 

I was completely overcome with shame, and survival guilt took up permanent residence in my heart: I swore that I would never let the memory of them get lost, and that I would always carry the torch for them.

 

I looked out the window and there on the street outside of the Hospital entrance a large “anti-war” demonstration was in progress and the hatred was directed at the wounded vets while my beloved Bravo Company was gone, they were all dead, wounded or missing. I was twenty years old and I absolutely hated America.

 

The article epitomizes what the misplaced guilt trip was all about: “115 Dead, 276 Wounded, 26 Missing, A Battle Without Victory: The Wipe-Out of Bravo Company.” There were no winners, only losers again; even the survivors lost."

And then, in an echo of why other teenagers self-harm, such as by cutting themselves, in an attempt to "balance" the pain externally with the pain they feel within, we hear Pat describe the aftermath for him:

 

"I spent the next 35 years trying to find out “why some people survived and others didn’t”. More specifically, I needed to understand why I had “dodged the bullet” when so many other Marines had “bought it”. I constantly sought a place where the pain going on around me and outside of me matched the pain inside my head and which was literally eating me alive.

 

As weird as this sounds, the more I hurt physically, the calmer I felt. Only physical pain could suppress the mental pain that was always present. It was as if I had to be constantly punished just to survive. "

Despite the thousands of words that Pat has written to describe his experiences, his description of this episode in his life made me wonder if it in fact was the pivotal episode of all.  As to why he didn't deck the world's most insensitive human being -- the Navy Corpsman who "dropped" that bit of "news" in his lap?  Pat says that if he hadn't been lying in the hospital bed, shot up and paralyzed on one side, he would have been happy to.  I can easily see why.