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June 13, 2008

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

CIMG0819 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.

June 10, 2008

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

Quilt Photos at VA in Seattle

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

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

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

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

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

[Cecil's wife, Bet, and I are spending time one afternoon.] We’re talking upstairs in the sewing room while she works on her Vietnam quilt. The room is stuffed with fabric: tweeds, cottons, velvets, hundreds of men’s ties. Bet sews at a small table by the window. She listens to oral histories of Vietnam 2428049925_b10a518f99 veterans as she works. On the left side of the quilt is an army-green map of Vietnam, showing the three cities where James, Cecil, and Arnold served. The rest of the quilt is blue, and three male figures float there, separated from one another and bearing labels: anger, despair, and guilt. The quilt reads: "my husband and his brothers came home from vietnam…three islands in an ocean of silence."  James is the Angry one, Cecil the figure of Despair, and Arnold is Guilt.

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

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

2428061461_139b0d92cb


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

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

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

May 11, 2008

Hey Mama: Celebrating Mother's Day for Veterans

Mom_ptsd

Happy Mother's Day to the mothers who've served in combat, and to the mothers, stepmothers, grandmothers, and adoptive or foster mothers of those who've served, not to mention the wives and girlfriends of combat veterans.  The veteran pays a heavy price for his or her sacrifice; but so do the generally unsung heroines on the homefront.  They're the ones struggling to make sense of the distance and loneliness; trying to hold down a job to keep the family afloat and tend to the children as well; and they're often called upon to pitch in as 24/7 caregivers or patient advocates when the need arises after injury.  Some of these women who we know personally are truly amazing role models, and due an enormous debt of gratitude and respect.  However, they're ALL worthy of appreciation for the mighty roles they fill.  Let's hope this Mother's Day they get just some of the gratitude they deserve.

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One veteran's mother, Frances Richey, did something unusual.  She wrote a book of poetry about being the mother of a son at war, called The Warrior.  Amazon.com, in its product description, calls it "A heartwrenching and powerful memoir in verse from a mother grappling with the reality of her son at war in Iraq."  Richey, a single mother, raised a son who went through West Point and became a Green Beret, serving multiple tours in Iraq.  Recently, the Seattle PI wrote an article about the book, called "Mother's poetry illustrates the pain she felt while her son fought in Iraq."  Click here for a link to the book, and here for a link to the article in the Seattle PI.   

May 02, 2008

Kathie Costos, Chaplain

Kathie_costos_3Kathie Costos, also known as "Nam Guardian Angel," is a certified, ordained Chaplain and member of the International Fellowship of Chaplains ("IFOC").  The daughter of a Korean War veteran, and the wife of a Vietnam veteran, she has been active in veterans issues since the 1970s.  For the last 25+ years, she has focused on Vietnam veterans with Post-Traumatic Stress Disorder.

As a chaplain with a devout Greek orthodox background, Kathie nevertheless believes that "no matter what church people belong to, they belong to the family of God as God's children."  Years of volunteering with Vietnam veterans and their families has taught her to take care of the spiritual needs of people and not just the already "faithful."

Kathie is the author of a well-regarded book, called For the Love of Jack, His War/My Battle -- about how her family coped with the legacy of PTSD that her husband returned with from the Vietnam War.  She self-published the book immediately after 9/11, out of concern that the word needed to get out about what PTSD was, before many more people began to suffer from it.  The book is available for downloading on her website, and Kathie has also produced many educational videos about PTSD that are also available on her website.  A list of those videos include the following, but because Kathie is always expanding the list of videos she's made about this topic so close to her heart, it also makes sense to "favorite" her on YouTube, where a list of all her videos is linked, here.  A list of those videos current as of this writing include the following (each is hyperlinked to YouTube or Google video, so you can watch them directly):

A link to Kathie's website about PTSD is here.  For a direct link to the book she wrote about her husband and family surviving PTSD, click here. For a link to her ever-expanding list of videos about PTSD and veterans, click here.

A favorite quote of Kathie's: "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.

March 25, 2008

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

Wmhch 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.

National Women's Trauma Recovery Program ("WTRP") for Women Veterans

Cimg2601_3More than a decade ago, the Department of Veterans Affairs opened the National Women's Trauma Recovery Program (WTRP) as part of the National Center for PTSD at Menlo Park, CA. The WTRP, designed to treat women veterans with post traumatic stress disorder (PTSD), is the first residential program of its kind and is open to women across the country. Many of the women who are referred to the program were sexually assaulted during their military service and suffer what is now referred to as Military Sexual Trauma (MST). The WTRP is intensive 60-day residential program with a strong emphasis on interpersonal skills. The initial two weeks of treatment involve psychological and psychosocial assessments in order to develop comprehensive treatment plans. Women come into the program in classes, or cohorts, and work together to problem-solve, learn effective communication, and better manage their PTSD/MST symptoms.

Here's a list of key links:

  • An overview of the Women's Trauma Recovery Program (WTRP), linked here.
  • A statement about who's eligible to attend, linked here.
  • The application itself, linked here.

The WTRP progam is headed by Darrah Westrup, Ph.D.  She has some positive, uplifting things to say about the program itself, including this quote: "our program is all about helping women reclaim their sense of worth and personal power." For more of her remarks, click here.  For more about Darrah Westrup, Ph.D., click here.

Special VA Programs Geared to Women Veterans

Lisa_veteran

It's a little late for International Women's Day (March 8th) and a little early for Mother's Day (May 11th), but it's time to talk about the special needs and concerns of women warriors, and how they're affected by combat trauma.  The most recent issue of the Disabled American Veterans' magazine has an article on women combat veterans.  The public service poster graphic in particular (see left) is impressive, as is its slogan: "War is Hell: Being a [Woman] Veteran Shouldn't Be."  Click on this link to download the March/April issue as a PDF; the article begins on page 19.

It's good news that the VA is becoming more attuned to the special needs of traumatized women veterans, either through PTSD or sexual trauma, or both.  Here's a section of the main VA website that addresses VA Programs for Women Veterans.  Click here for that link.  The programs cover several important areas, including mental health and sexual abuse counseling; medical services for women veterans; education and training; research; compensation for women veterans; national cemetery administration; and demographic trends.  According to the VA's own website, women veterans should be able to get help by contacting the nearest VA center, and asking to speak to the women's program manager, who will be able to refer them to the right help.  To review the briefly-noted information on the VA website, click here.

There's also a physical facility at the VA Palo Alto Health Care System devoted to women's recovery from trauma, both combat trauma and military sexual trauma (MST).  That program is known as Women's Trauma Recovery Program, or WTRP, and it's housed in a facility, called the Women's Mental Health Center Home.  This program is open to women from all wars, with programs being developed to focus on OEF/OIF veterans.  For more from the VA about women veterans with MST, click here.

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Statistically speaking, according to the VA:

The estimated population of women veterans as of 2001 was 1.6 million, or about 7.2 percent of the total veteran population.  10.26% of the 22.8 million veterans who use VA for healthcare are women.  Currently, women make up 14.8 percent of the active duty military force and approximately 22.8 percent of the reserve force.  By 2010, they are expected to represent over 14 percent of the total veteran population.  Fifty-six percent of women veterans who use VA are less than 45 years of age.  Sixty-two percent of women veterans are less than 45 years of age.

When it comes to women veterans and Military Sexual Trauma, though, the figures are worse.  We've done a blog post about that separately.  To read that, click here.

Making a Fractured Heart Whole Again - Military Sexual Abuse and Women

Broken_heartThe Buffalo News has an excellent feature story in today's paper about a residential program at the VA for women who are survivors of military sexual abuse, among other forms of trauma.  The residential program profiled in Batavia, NY is one of four such programs the VA runs in the country.  Others will be profiled in future blog posts.  The article is entitled, "Female Veterans Find Help with Emotional Wounds at Batavia Facility."  Go here and read the story.  For a somewhat generic link to the VA's position on women veterans with military sexual trauma (MST), click here.  For a link to the actual VA residential program for women veterans in Batavia, NY, mentioned above, click here.

On the West Coast, there is the Women’s Trauma Recovery Program (WTRP), opened by the Palo Alto, CA VA in 1992 as part of the National Center for PTSD. It is an intensive 60-day residential program with and emphasis on interpersonal skills and a focus on war-zone related stress as well as MST (Military Sexual Trauma).  For a link to a blog post discussing that in greater depth, click here.

There's also a residential program for women at the VA in Tyler, Texas.  And apparently there is a fourth program as well, but an hour plus surfing the VA's inscrutable website doesn't clarify where that is.  When I find out, I'll include the information.  For a link to the Central Texas program, click here.

March 24, 2008

Helping Families to Recognize Veterans' PTSD

Cimg0819_2The 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.

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